Healthcare Provider Details

I. General information

NPI: 1558365585
Provider Name (Legal Business Name): ALAN ELLMAN - HARVEY LINDENBAUM DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MIDDLE COUNTRY RD
MIDDLE ISLAND NY
11953-2542
US

IV. Provider business mailing address

770 MIDDLE COUNTRY RD
MIDDLE ISLAND NY
11953-2542
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-7997
  • Fax: 631-924-7953
Mailing address:
  • Phone: 631-924-7997
  • Fax: 631-924-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number29544
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29649
License Number StateNY

VIII. Authorized Official

Name: DR. HARVEY LINDENBAUM
Title or Position: OWNER
Credential: DDS
Phone: 631-924-7997