| NPI | 1114331253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH JAMES NICOLS President 631-587-9766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NY 023442) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2014-06-17 |