| Black Hall Dental, P.c. | |
|
400 Community Dr Manhasset NY 11030-3815 | |
| (516) 562-4525 | |
| (516) 562-2470 |
| Full Name | Black Hall Dental, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 400 Community Dr, Manhasset, New York |
| Authorized Official Name and Position | Michele L Cusack (SENIOR VICE PRESIDENT & CFO) |
| Authorized Official Contact | 5163216058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Hall Dental, P.c. 400 Community Dr Manhasset NY 11030-3815 Ph: (516) 562-4525 | Black Hall Dental, P.c. 400 Community Dr Manhasset NY 11030-3815 Ph: (516) 562-4525 |
| NPI Number | 1356091516 |
|---|---|
| Provider Enumeration Date | 03/28/2022 |
| Last Update Date | 03/28/2022 |
| Medicare PECOS PAC ID | 6901283308 |
|---|---|
| Medicare Enrollment ID | O20220524000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356091516 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Elisheva Rosenfeld |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1053571463 PECOS PAC ID: 7113244971 Enrollment ID: I20150317000102 |
| Provider Name | Kathleen M Schultz |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1043633365 PECOS PAC ID: 9830433937 Enrollment ID: I20190805001402 |
| Provider Name | Theresa C Fan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1306921820 PECOS PAC ID: 7618258534 Enrollment ID: I20200810000209 |
| Provider Name | Stephen Roth |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1083187538 PECOS PAC ID: 2769727460 Enrollment ID: I20210723000052 |
| Provider Name | Andrew R Salama |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1386788479 PECOS PAC ID: 5193895829 Enrollment ID: I20220126002599 |
| Provider Name | Monika Patel |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1457885923 PECOS PAC ID: 2769728229 Enrollment ID: I20230112002200 |
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