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General NPI Number Information
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NPI Number | 1942669387
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Entity Type | Organization
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Legal Business Name | BROOKLYN ORAL SURGERY & IMPLANT CENTER
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Dates
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Enumeration Date | 02/13/2016
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 1512 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-3808
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Country | US
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Telephone | 718-395-4700
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Fax | 718-395-4709
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Provider Business Mailing Address
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Address Line | 1512 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-3808
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Country | US
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Telephone | 718-395-4700
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Fax | 718-395-4709
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARRY SHNAYDER
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Credential | DDS
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Telephone | 718-702-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 055345
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License Number State | NY
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