Healthcare Provider Details

I. General information

NPI: 1922069293
Provider Name (Legal Business Name): MICHAEL E. LESSIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE LONG ISLAND JEWISH MEDICAL CENTER
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE LONG ISLAND JEWISH MEDICAL CENTER
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7113
  • Fax: 718-470-3483
Mailing address:
  • Phone: 718-470-7113
  • Fax: 718-470-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS026634R
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number053824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: