Provider Demographics
NPI:1386972388
Name:PROSTHODONTIC ASSOC. OF LONG ISLAND
Entity type:Organization
Organization Name:PROSTHODONTIC ASSOC. OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-627-0999
Mailing Address - Street 1:ONE HOLLOW LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-627-0999
Mailing Address - Fax:516-627-0905
Practice Address - Street 1:ONE HOLLOW LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-627-0999
Practice Address - Fax:516-627-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty