Provider Demographics
NPI:1124327135
Name:NEW YORK ORAL MAXILLOFACIAL AND IMPLANT SURGERY P.C.
Entity type:Organization
Organization Name:NEW YORK ORAL MAXILLOFACIAL AND IMPLANT SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:914-472-0100
Mailing Address - Street 1:495 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1068
Mailing Address - Country:US
Mailing Address - Phone:914-472-0100
Mailing Address - Fax:914-472-1563
Practice Address - Street 1:495 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1068
Practice Address - Country:US
Practice Address - Phone:914-472-0100
Practice Address - Fax:914-472-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204E00000X
NY0495121223S0112X
NY0328431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00285089Medicaid
D7B241Medicare Oscar/Certification
NYD2F051Medicare Oscar/Certification
D7B241Medicare Oscar/Certification
NY1881753788OtherNPI
NY1992864151OtherNPI