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General NPI Number Information
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NPI Number | 1154299352
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Entity Type | Organization
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Legal Business Name | LONG ISLAND ORTHODONTICS OF NORTH SHORE PLLC
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Dates
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Enumeration Date | 10/28/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1 SCHOOL ST STE 304
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City | GLEN COVE
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State | NY
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Zip | 11542-2529
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Country | US
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Telephone | 516-674-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SCHOOL ST STE 304
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City | GLEN COVE
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State | NY
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Zip | 11542-2529
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Country | US
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Telephone | 516-674-4557
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ISAAC MIZRAHI
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Credential |
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Telephone | 646-413-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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