Provider Demographics
NPI:1538551296
Name:BRONX ORAL SURGERY, PC
Entity type:Organization
Organization Name:BRONX ORAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-292-7117
Mailing Address - Street 1:355 E 149TH ST RM 206
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3909
Mailing Address - Country:US
Mailing Address - Phone:718-292-7117
Mailing Address - Fax:718-292-5105
Practice Address - Street 1:355 E 149TH ST RM 206
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3909
Practice Address - Country:US
Practice Address - Phone:718-292-7117
Practice Address - Fax:718-292-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659455194Medicaid