Healthcare Provider Details

I. General information

NPI: 1699782219
Provider Name (Legal Business Name): NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE SUITE N-10
NEW HYDE PARK NY
11042-1011
US

IV. Provider business mailing address

2001 MARCUS AVE SUITE N-10
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-1818
  • Fax: 516-775-0892
Mailing address:
  • Phone: 516-775-1818
  • Fax: 516-775-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number024890
License Number StateNY

VIII. Authorized Official

Name: BIBI MAJEED
Title or Position: PATIENT ACCOUNTS
Credential: DO
Phone: 516-775-1818