MEDICARE: SHEEPSHEAD BAY ORAL SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	049375	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336256338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEEPSHEAD BAY ORAL SURGERY

Provider Business Mailing Address
First Line	:	1918 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3906
Country	:	US
Telephone Number	:	718-743-5400
Fax Number	:	718-743-4125

Provider Business Practice Location Address
First Line	:	1918 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3906
Country	:	US
Telephone Number	:	718-743-5400
Fax Number	:	718-743-4125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BORIS ZATS
Credential	:	DDS
Telephone Number	:	718-743-5400

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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