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General NPI Number Information
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NPI Number | 1730329301
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Entity Type | Organization
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Legal Business Name | GREENWICH ORAL AND MAXILLOFACIAL SURGERY ASSOC.
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 14 RYE RIDGE PLAZA SUITE 234
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City | RYE BROOK
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State | NY
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Zip | 10573
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Country | US
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Telephone | 914-253-9088
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Fax | 914-253-4925
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Provider Business Mailing Address
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Address Line | 14 RYE RIDGE PLAZA SUITE 234
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City | RYE BROOK
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State | NY
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Zip | 10573
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Country | US
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Telephone | 914-253-9088
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Fax | 914-253-4925
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN MARK BRODY
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Credential | D.D.S.
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Telephone | 914-253-9088
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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 | 03318
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License Number State | NY
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