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590 Jericho Tpke Syosset NY 11791-4522 | |
| (516) 433-2211 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 590 Jericho Tpke, Syosset, New York |
| Authorized Official Name and Position | Jenny Garcia-rocha (SR CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
590 Jericho Tpke Syosset NY 11791-4522 Ph: () - | 590 Jericho Tpke Syosset NY 11791-4522 Ph: (516) 433-2211 |
| NPI Number | 1669280178 |
|---|---|
| Provider Enumeration Date | 12/30/2024 |
| Last Update Date | 01/03/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669280178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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