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General NPI Number Information
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NPI Number | 1144468877
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Entity Type | Organization
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Legal Business Name | CRANIOFACIAL SURGERY, P.C.
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 155 COUNTRY RIDGE RD
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City | SCARSDALE
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State | NY
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Zip | 10583-6625
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Country | US
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Telephone | 786-380-0650
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Fax | 914-723-9236
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Provider Business Mailing Address
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Address Line | 935 PARK AVE STE 1B
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City | NEW YORK
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State | NY
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Zip | 10028-0212
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Country | US
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Telephone | 212-628-8880
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Fax | 800-476-4306
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. DOMINICK I. GOLIO
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Credential | M.D.
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Telephone | 212-628-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 87053
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License Number State | FL
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