| Stony Brook Oral And Facial Surgery Pc | |
|
207 Hallock Rd Suite 2 Stony Brook NY 11790-3033 | |
| (631) 675-9601 | |
| (631) 675-9602 |
| Full Name | Stony Brook Oral And Facial Surgery Pc |
|---|---|
| Speciality | Dentist |
| Location | 207 Hallock Rd, Stony Brook, New York |
| Authorized Official Name and Position | Michael Proothi (OWNER) |
| Authorized Official Contact | 6316759601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stony Brook Oral And Facial Surgery Pc 207 Hallock Rd Suite 2 Stony Brook NY 11790-3033 Ph: (631) 675-9601 | Stony Brook Oral And Facial Surgery Pc 207 Hallock Rd Suite 2 Stony Brook NY 11790-3033 Ph: (631) 675-9601 |
| NPI Number | 1497289037 |
|---|---|
| Provider Enumeration Date | 04/19/2017 |
| Last Update Date | 02/29/2024 |
| Medicare PECOS PAC ID | 4688951189 |
|---|---|
| Medicare Enrollment ID | O20170511000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497289037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 051735-1 (New York) | Primary |
| Provider Name | Michael Proothi |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1124279856 PECOS PAC ID: 5496879355 Enrollment ID: I20100830000072 |
| Provider Name | Mitchell Steinberg |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1942540281 PECOS PAC ID: 8921343583 Enrollment ID: I20210908000769 |
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