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General NPI Number Information
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NPI Number | 1912080417
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Entity Type | Organization
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Legal Business Name | LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 134 MINEOLA BLVD. 3 FLOOR
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City | MINEOLA
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State | NY
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Zip | 11501
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Country | US
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Telephone | 516-294-9696
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Fax | 516-294-3531
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Provider Business Mailing Address
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Address Line | 134 MINEOLA BLVD. 3 FLOOR
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City | MINEOLA
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State | NY
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Zip | 11501
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Country | US
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Telephone | 516-294-9696
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Fax | 516-294-3531
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DEBRA MCQUILLAN
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Credential |
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Telephone | 516-294-9696
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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 | NY
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