Healthcare Provider Details

I. General information

NPI: 1578788824
Provider Name (Legal Business Name): BRIAN S MARGOLIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GLEN HEAD RD STE 170
OLD BROOKVILLE NY
11545
US

IV. Provider business mailing address

333 GLEN HEAD RD STE 170
OLD BROOKVILLE NY
11545
US

V. Phone/Fax

Practice location:
  • Phone: 516-484-4741
  • Fax: 516-484-6058
Mailing address:
  • Phone: 516-993-9290
  • Fax: 516-484-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number042115
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number042155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: