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General NPI Number Information
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NPI Number | 1538551296
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Entity Type | Organization
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Legal Business Name | BRONX ORAL SURGERY, PC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 355 E 149TH ST RM 206
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City | BRONX
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State | NY
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Zip | 10455-3909
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Country | US
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Telephone | 718-292-7117
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Fax | 718-292-5105
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Provider Business Mailing Address
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Address Line | 355 E 149TH ST RM 206
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City | BRONX
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State | NY
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Zip | 10455-3909
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Country | US
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Telephone | 718-292-7117
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Fax | 718-292-5105
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Authorized Official
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Title or Position | OWNER
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Name | JERALD STEVEN FRIEDMAN
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Credential | DDS
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Telephone | 718-292-7117
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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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