Healthcare Provider Details

I. General information

NPI: 1730202862
Provider Name (Legal Business Name): PAUL VICTOR SNISKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CENTRAL AVENUE
SCARSDALE NY
10583
US

IV. Provider business mailing address

41 MEADOWLARK RD
RYE BROOK NY
10573-1221
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-0808
  • Fax: 914-723-0618
Mailing address:
  • Phone: 914-933-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number044881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: