Healthcare Provider Details

I. General information

NPI: 1508252073
Provider Name (Legal Business Name): LEVON NIKOYAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 04/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24862 JERICHO TPKE
FLORAL PARK NY
11001-4002
US

IV. Provider business mailing address

24862 JERICHO TPKE
FLORAL PARK NY
11001-4002
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-2220
  • Fax:
Mailing address:
  • Phone: 516-775-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number056226
License Number StateNY

VIII. Authorized Official

Name: DR. LEVON NIKOYAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 516-775-2220