Healthcare Provider Details

I. General information

NPI: 1891150348
Provider Name (Legal Business Name): J BIEBER ORAL AND MAXILLOFACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 ROUTE 52
FISHKILL NY
12524-1516
US

IV. Provider business mailing address

841 ROUTE 52
FISHKILL NY
12524-1516
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-8424
  • Fax:
Mailing address:
  • Phone: 845-896-8424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number030759-1
License Number StateNY

VIII. Authorized Official

Name: JOSEF BIEBER
Title or Position: DOCTOR
Credential: DDS
Phone: 845-896-8424