Healthcare Provider Details

I. General information

NPI: 1801047634
Provider Name (Legal Business Name): HANUMAN ORAL SURGERY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 BRITTON AVE APT 2C
ELMHURST NY
11373-2433
US

IV. Provider business mailing address

8201 BRITTON AVE APT 2C
ELMHURST NY
11373-2433
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-2347
  • Fax:
Mailing address:
  • Phone: 212-927-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number051569
License Number StateNY

VIII. Authorized Official

Name: MRS. MARIA DELGADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 212-927-2347