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NPI 1154509503

NPI 1154509503 : MICHAEL YEHUDA IVRY DDS : VALLEY STREAM, NY

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General NPI Number Information
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    NPI Number           |    1154509503
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    Entity Type          |    Individual 
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    Provider Name        |    MICHAEL YEHUDA IVRY DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    02/07/2008
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    Last Update Date     |    05/30/2018
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Provider Practice Location Address
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    Address Line         |    44 S CENTRAL AVE STE 2 
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    City                 |    VALLEY STREAM
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    State                |    NY
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    Zip                  |    11580
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    Country              |    US
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    Telephone            |    516-561-7788
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    Fax                  |    516-596-7455
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Provider Business Mailing Address
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    Address Line         |    943 HAWKINS AVE 
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    City                 |    LAKE GROVE
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    State                |    NY
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    Zip                  |    11755-1604
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    Country              |    US
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    Telephone            |    631-585-6880
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    Fax                  |    631-585-0745
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    0479621
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    License Number State |    NY
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