Provider Demographics
NPI:1699782219
Name:NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY PC
Entity type:Organization
Organization Name:NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:BIBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJEED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-775-1818
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N-10
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-775-1818
Mailing Address - Fax:516-775-0892
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N-10
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-775-1818
Practice Address - Fax:516-775-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024890204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01145546Medicaid
NY01559719Medicaid
NY02212444Medicaid
NY02238062Medicaid
NY01335919Medicaid
NY00501157Medicaid
NY01463525Medicaid
NYD5L121Medicare ID - Type UnspecifiedSTEPHANIE DREW
NY01463525Medicaid
NYT50408Medicare UPIN
NYU32120Medicare UPIN
NYH49369Medicare UPIN
NY01145546Medicaid
NYDE1671Medicare ID - Type UnspecifiedJAY NEUGARTEN
NYD99311Medicare ID - Type UnspecifiedSTEPHEN SACHS
NY01559719Medicaid
NYT50408Medicare UPIN