Healthcare Provider Details

I. General information

NPI: 1972522118
Provider Name (Legal Business Name): STEVEN MITCHNICK, DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 LONG BEACH RD STE 7
OCEANSIDE NY
11572-3240
US

IV. Provider business mailing address

3051 LONG BEACH RD STE 7
OCEANSIDE NY
11572-3240
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-1516
  • Fax: 516-255-4693
Mailing address:
  • Phone: 516-766-1516
  • Fax: 516-255-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0440831
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN MITCHNICK
Title or Position: OWNER
Credential: D.M.D.
Phone: 516-766-1516