Healthcare Provider Details

I. General information

NPI: 1982323036
Provider Name (Legal Business Name): OMS NEW YORK ORAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVE FL 18
NEW YORK NY
10022-5613
US

IV. Provider business mailing address

501 MADISON AVE FL 18
NEW YORK NY
10022-5613
US

V. Phone/Fax

Practice location:
  • Phone: 212-308-9200
  • Fax:
Mailing address:
  • Phone: 917-364-3854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALLEN GLIED
Title or Position: OWNER
Credential: DDS
Phone: 917-364-3854