| Staten Island Oral & Maxillofacial Surgery | |
|
256c Mason Ave Staten Island NY 10305-3408 | |
| (718) 226-1251 | |
| (718) 226-1252 |
| Full Name | Staten Island Oral & Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 256c Mason Ave, Staten Island, New York |
| Authorized Official Name and Position | David C Hoffman (PRESIDENT) |
| Authorized Official Contact | 7182261251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staten Island Oral & Maxillofacial Surgery 256 Mason Ave # C Staten Island NY 10305-3408 Ph: (718) 226-1251 | Staten Island Oral & Maxillofacial Surgery 256c Mason Ave Staten Island NY 10305-3408 Ph: (718) 226-1251 |
| NPI Number | 1316217763 |
|---|---|
| Provider Enumeration Date | 01/03/2012 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 4486821709 |
|---|---|
| Medicare Enrollment ID | O20120126000740 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316217763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 033292 (New York) | Primary |
| Provider Name | Mark Stein |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1093778102 PECOS PAC ID: 5991695116 Enrollment ID: I20040319000150 |
| Provider Name | Joshua D Segal |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1154595734 PECOS PAC ID: 4688829328 Enrollment ID: I20130301000128 |
| Provider Name | Steve Yusupov |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1982991485 PECOS PAC ID: 9032482104 Enrollment ID: I20170912001720 |
| Provider Name | Lydia J Lam |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1649542523 PECOS PAC ID: 5395085567 Enrollment ID: I20190326001004 |
| Provider Name | Emad Abdou |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1174914766 PECOS PAC ID: 6608269147 Enrollment ID: I20220207000388 |
| Provider Name | Mark Goodenough |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1154858033 PECOS PAC ID: 6800240433 Enrollment ID: I20230929001677 |
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