NORTH SHORE ORAL SURGERY, LLC (NPI# 1619249059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619249059 |
| Entity Type | Organization |
| Organization Name | NORTH SHORE ORAL SURGERY, LLC |
| Practice Address |
285 Middle Country Rd Suite #108 Smithtown NY 11787-2978 |
| Practice Telephone | 6312659700 |
| Practice Fax Number | 6312659703 |
| Mailing Telephone | 6312659700 |
| Mailing Fax Number | 6312659703 |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2016-11-30 |
| Authorized Official Name | ALEX MONTAZEM (DOCTOR/OWNER) |
| Authorized Official Telephone | 6312659700 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
042730 | NY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | CIGNA DMO | 116561 | 01 |
| NY | UNITED HEALTHCARE | 1364282 | 01 |
| NY | OXFORD | P3492579 | 01 |
| NY | HIP | 521422P | 01 |
| NY | EMPIRE BCBS | D99121 | 01 |
| NY | GHI MEDICAL | 0565561 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | NORTH SHORE ORAL SURGERY, LLC | 222 Middle Country Rd, Ste 101, Smithtown, Ny 11787 |
| Street Address |
285 MIDDLE COUNTRY RD SUITE #108 |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-2978 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548249873 | Timothy James Murphy IIi | Dentist | 285 Middle Country Rd, Suite Ll-7, Smithtown, NY 11787-2978 | 2006-01-13 |
| 1912531542 | Niti Praveen Mohan | Internal Medicine | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2020-02-21 |
| 1578043881 | Melissa Rodzen | Physician Assistant | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2018-08-16 |
| 1699201970 | Beena Jacob | Nurse Practitioner | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2017-05-05 |
| 1023487410 | Sj Chiropractic, P.C. | Chiropractor | 285 Middle Country Rd, Ste 204, Smithtown, NY 11787-2978 | 2015-09-16 |
| 1326421942 | Melanie Perlson | Clinic/Center | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2015-07-01 |
| 1801155130 | New York Spine Care Medical, PC | Physical Medicine & Rehabilitation | 285 Middle Country Rd, Suite- Ll6, Smithtown, NY 11787-2978 | 2012-05-07 |
| 1760717292 | Smithtown Endodontics P.C. | Dentist | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2009-10-16 |
| 1295068930 | Middle Country Endocrinology, PC | Internal Medicine | 285 Middle Country Rd, Suite 105, Smithtown, NY 11787-2978 | 2009-09-14 |
| 1497988752 | Joseph Frank Dibernardo | Dentist | 285 Middle Country Rd, Smithtown, NY 11787-2978 | 2009-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
| Find all providers in zip 11787 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992965909 | Joel S Teig | Dentist | 11 Everit Pl, Smithtown, NY 11787-1703 | 2008-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053921643 | Upper West Side Oral & Maxillofacial Surgery | Dentist | 140 W 69th St Ph 1g, New York, NY 10023-5173 | 2020-08-07 |
| 1467092965 | Nyc Implant and Oral Surgery PC | Dentist | 30 E 60th St Ste 907, New York, NY 10022-1058 | 2020-01-13 |
| 1235777566 | Asnis Dental Pllc | Dentist | 800 Woodbury Rd Ste C, Woodbury, NY 11797-2503 | 2019-12-17 |
| 1700420429 | Chavkin Oral and Maxillofacial Surgery LLC | Dentist | 414 Jericho Tpke Ste 2, New Hyde Park, NY 11040-4510 | 2019-11-06 |
| 1730737545 | Southwoods Boulevard Dental, P.C. | Dentist | 7 Southwoods Blvd Ste 1, Albany, NY 12211-2526 | 2019-08-27 |
| 1750947792 | Eduard Munarov Dds PC | Dentist | 449 N State Rd Ste 102, Briarcliff Manor, NY 10510-1478 | 2019-05-15 |
| 1598227530 | Asnis Dental Pllc | Dentist | 250 Patchogue Yaphank Rd Ste 10, East Patchogue, NY 11772-4862 | 2019-04-01 |
| 1720545387 | Asnis Dental, Pllc | Dentist | 260 Middle Country Rd Ste 12, Selden, NY 11784-2570 | 2019-03-01 |
| 1205344819 | Ray Cheng Dds | Dentist | 217 Park Row Ste 4b, New York, NY 10038-1101 | 2018-01-17 |
| 1871006064 | Ny Oral and Maxillofacial Surgeon, PC | Dentist | 2844 Ocean Pkwy Ste B2, Brooklyn, NY 11235-7904 | 2017-11-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.