=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801047634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANUMAN ORAL SURGERY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2008
-----------------------------------------------------
Last Update Date | 10/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8201 BRITTON AVE APT 2C
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-927-2347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8201 BRITTON AVE APT 2C
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-927-2347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MARIA DELGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-927-2347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 051569
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------