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General NPI Number Information
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NPI Number | 1457785024
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY ASSOCIATES P.C.
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 4300 HYLAN BLVD SUITE 2G
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6507
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Country | US
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Telephone | 718-967-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 HYLAN BLVD SUITE 2G
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | GREG PANOSSIAN
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Credential | DDS
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Telephone | 718-967-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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