Park East Oral & Maxillofacial Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

033118 Issued in NY

Legal business name

PARK EAST ORAL & MAXILLOFACIAL SURGERY PC

Practice address

521 Park Ave
New York, NY 10065-8140

Phone

(212) 593-2930

Fax

(212) 593-2931

NPI assigned

Sep 15, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Seth Martin Black, DDS

Title

Owner

Phone

(212) 593-2930

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347667200000",
    "number": "1033469135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100658140",
            "telephone_number": "212-593-2930",
            "fax_number": "212-593-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100658140",
            "telephone_number": "212-593-2930",
            "fax_number": "212-593-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK EAST ORAL & MAXILLOFACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-15",
        "last_updated": "2012-09-15",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "SETH",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-593-2930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "033118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0707035",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in New York, NY
• Providers in New York, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.