| NPI | 1083033773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAJU MATHEW Owner 631-235-9007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 050711) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-05-29 |