Healthcare Provider Details

I. General information

NPI: 1255796553
Provider Name (Legal Business Name): YONKERS ORAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MARKET STREET SUITE 377
YONKERS NY
10710
US

IV. Provider business mailing address

73 MARKET STREET SUITE 377
YONKERS NY
10710
US

V. Phone/Fax

Practice location:
  • Phone: 914-779-5606
  • Fax: 914-968-2474
Mailing address:
  • Phone: 914-779-5606
  • Fax: 914-968-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: HELEN ANN PEREZ
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 914-472-5252