Healthcare Provider Details

I. General information

NPI: 1548741267
Provider Name (Legal Business Name): P. ENDODONTICS OF HICKSVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH OYSTER BAY ROAD SUITE 301
HICKSVILLE NY
11801
US

IV. Provider business mailing address

400 SOUTH OYSTER BAY ROAD SUITE 301
HICKSVILLE NY
11801
US

V. Phone/Fax

Practice location:
  • Phone: 516-217-7000
  • Fax:
Mailing address:
  • Phone: 516-217-7000
  • Fax: 516-513-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ASHISH SAHASRABUDHE
Title or Position: OWNER
Credential: D.M.D.
Phone: 516-222-1822