| NPI | 1336631035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL YEHUDA IVRY Owner 631-252-2076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 047962) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-05-30 |