East 63Rd Street

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

056681 Issued in NY

Legal business name

EAST 63RD STREET

Doing business as

Advanced Oral Surgery NYC

Practice address

250 E 63Rd St
New York, NY 10065-7661

Phone

(212) 644-7009

NPI assigned

Dec 10, 2013

Last updated

Dec 10, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Baruch Tetri, DDSNPI 1174855472

Title

DDS

Phone

(212) 759-5363

Specialties & licenses 1

Addresses

Other names 1

• Advanced Oral Surgery NYC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Baruch Tetri, DDS

  • Periodontics
  • New York, NY
  • NPI 1174855472
  Authorized official Same address or phone

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386633600000",
    "number": "1811328297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E 63RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657661",
            "telephone_number": "212-644-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E 63RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657661",
            "telephone_number": "212-644-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST 63RD STREET",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2013-12-10",
        "status": "A",
        "authorized_official_last_name": "TETRI",
        "authorized_official_first_name": "BARUCH",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "212-759-5363",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "056681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Oral Surgery NYC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 Dec 10, 2013; 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.