| NPI | 1619286887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHEW JAMES PT Accounts 631-827-8159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 2476621) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2010-10-05 |