Healthcare Provider Details

I. General information

NPI: 1619185295
Provider Name (Legal Business Name): IRVING SCHULTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GREG LN
EAST NORTHPORT NY
11731-5522
US

IV. Provider business mailing address

1 GREG LANE
EAST NORTHPORT NY
11731-5522
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-4900
  • Fax: 631-499-3694
Mailing address:
  • Phone: 631-499-4900
  • Fax: 631-499-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: