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General NPI Number Information
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NPI Number | 1598029779
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTICS OF LONG ISLAND, P.C.
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 18A
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City | STONY BROOK
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State | NY
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Zip | 11790-2563
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Country | US
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Telephone | 631-751-1400
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Fax | 631-751-1996
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 18A
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City | STONY BROOK
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State | NY
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Zip | 11790-2563
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Country | US
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Telephone | 631-751-1400
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Fax | 631-751-1996
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME JACOB CYMERMAN
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Credential | D.M.D.
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Telephone | 631-751-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 035582
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License Number State | NY
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