Healthcare Provider Details

I. General information

NPI: 1629443379
Provider Name (Legal Business Name): HUDSON VALLEY ORAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 STRANG BLVD STE 202 HUDSON VALLEY ORAL SURGERY, PLLC
YORKTOWN HEIGHTS NY
10598-2938
US

IV. Provider business mailing address

2649 STRANG BLVD., SUITE 202 HUDSON VALLEY ORAL SURGERY, PLLC
YORKTOWN HTS. NY
10598
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-6642
  • Fax:
Mailing address:
  • Phone: 914-245-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number055476
License Number StateNY

VIII. Authorized Official

Name: ALI PAYAMI
Title or Position: PARTNER
Credential: DMD, MD
Phone: 914-245-6642