Provider Demographics
NPI:1205999380
Name:ORAL MAXILLOFACIAL SURGERY OF THE SOUTHERN TIER, PC
Entity type:Organization
Organization Name:ORAL MAXILLOFACIAL SURGERY OF THE SOUTHERN TIER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:607-733-3760
Mailing Address - Street 1:451 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2636
Mailing Address - Country:US
Mailing Address - Phone:607-733-3760
Mailing Address - Fax:607-734-6000
Practice Address - Street 1:451 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2636
Practice Address - Country:US
Practice Address - Phone:607-733-3760
Practice Address - Fax:607-734-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942299094OtherNPI WILLIAM F. POCHAL
NY1851381867OtherNPI MATTHEW B. BROWN
NY1780674796OtherNPI DANIEL H. FARR
NY38182EMedicare ID - Type UnspecifiedWILLIAM F. POCHAL ELMIRA
NYG27549Medicare UPIN
NYU01869Medicare UPIN
NY38183AMedicare ID - Type UnspecifiedGROUP NUMBER CORNING
NY38183EMedicare ID - Type UnspecifiedDANIEL H FARR CORNING
NY53025CMedicare ID - Type UnspecifiedWILLIAM F POCHAL WAVERLY
NY1780674796OtherNPI DANIEL H. FARR
NY38182AMedicare ID - Type UnspecifiedGROUP NUMBER ELMIRA
NY1942299094OtherNPI WILLIAM F. POCHAL
NY53025DMedicare ID - Type UnspecifiedDANIEL H FARR WAVERLY
NY53025AMedicare ID - Type UnspecifiedGROUP NUMBER WAVERLY
NY53025EMedicare ID - Type UnspecifiedMATTHEW B BROWN WAVERLY
NY38183FMedicare ID - Type UnspecifiedMATTHEW B BROWN CORNING
NY38182FMedicare ID - Type UnspecifiedDANIEL H. FARR ELMIRA
NYF20948Medicare UPIN