Healthcare Provider Details

I. General information

NPI: 1467568733
Provider Name (Legal Business Name): PANKAJ PAL SINGH DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WOODBURY RD STE D
WOODBURY NY
11797-2503
US

IV. Provider business mailing address

4 IVY CT
GLEN HEAD NY
11545-3133
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-8010
  • Fax: 516-484-9632
Mailing address:
  • Phone: 516-724-0654
  • Fax: 516-723-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45022
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number45022
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number000067
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number45022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: