Healthcare Provider Details

I. General information

NPI: 1467812834
Provider Name (Legal Business Name): DR MICHAEL E LESSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE DEPARTMENT OF DENTAL MEDICINE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE DEPARTMENT OF DENTAL MEDICINE
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7130
  • Fax: 718-470-5423
Mailing address:
  • Phone: 718-470-7130
  • Fax: 718-470-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number053824-1
License Number StateNY

VIII. Authorized Official

Name: MRS. MARILYN CARABAJO
Title or Position: SECRETARY
Credential:
Phone: 718-470-7130