Provider Demographics
NPI:1225220247
Name:LONG ISLAND ORAL SURGERY ASSOCIATES, PC.
Entity type:Organization
Organization Name:LONG ISLAND ORAL SURGERY ASSOCIATES, PC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-333-5900
Mailing Address - Street 1:175 JERICHO TPKE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4532
Mailing Address - Country:US
Mailing Address - Phone:516-921-2880
Mailing Address - Fax:516-921-2889
Practice Address - Street 1:959 BRUSH HOLLOW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1778
Practice Address - Country:US
Practice Address - Phone:516-333-5900
Practice Address - Fax:516-333-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDOW771Medicare UPIN