NPIMap

Organization Active NPI

Long Island Oral & Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mineola, NY
National Provider Identifier
1912080417
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC
Practice address
134 Mineola Blvd.
3 Floor
Mineola, NY 11501
Phone
(516) 294-9696
Fax
(516) 294-3531
NPI assigned
Oct 20, 2006
Last updated
Jan 11, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

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

Authorized official

Name
Mrs. Debra McQuillan
Title
Manager
Phone
(516) 294-9696

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NY Primary

Addresses

Primary practice location

134 Mineola Blvd.
3 Floor
Mineola, NY 11501

Mailing address

134 Mineola Blvd.
3 Floor
Mineola, NY 11501
Phone (516) 294-9696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000107 NY Part B Supplier - Clinic/Group Practice 2668362674 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Mineola, NY; Port Washington, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Long Island Oral Maxillofacial Surgery PC2 organizations share this tax ID, including this one
Part of
Long Island Oral Maxillofacial Surgery PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

134 Mineola Blvd
#3
Mineola, NY 11501
Phone (516) 294-9696

134 Mineola Blvd
Ste 302
Mineola, NY 11501
Phone (516) 294-9696

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1912080417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 MINEOLA BLVD.",
            "address_2": "3 FLOOR",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "11501",
            "telephone_number": "516-294-9696",
            "fax_number": "516-294-3531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MINEOLA BLVD.",
            "address_2": "3 FLOOR",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "11501",
            "telephone_number": "516-294-9696",
            "fax_number": "516-294-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC",
        "enumeration_date": "2006-10-20",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "MCQUILLAN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "516-294-9696",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.