MEDICARE: SHATZ ORTHODONTICS, PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047087	OTHER	NY	DENTAL LICENSE

General Provider Information

NPI Number	:	1659002129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHATZ ORTHODONTICS, PLLC

Provider Business Mailing Address
First Line	:	3471 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5424
Country	:	US
Telephone Number	:	516-536-5800
Fax Number	:	516-208-7447

Provider Business Practice Location Address
First Line	:	3471 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5424
Country	:	US
Telephone Number	:	516-536-5800
Fax Number	:	516-208-7447

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADAM DAVID SHATZ
Credential	:	DDS
Telephone Number	:	516-536-5800

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	03/07/2023

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