Provider Demographics
NPI:1548632896
Name:ORAL SURGERY OF NNY PLLC
Entity type:Organization
Organization Name:ORAL SURGERY OF NNY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNEEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-786-3990
Mailing Address - Street 1:163 BELLEW AVE S
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2390
Mailing Address - Country:US
Mailing Address - Phone:315-786-3990
Mailing Address - Fax:315-786-3991
Practice Address - Street 1:163 BELLEW AVE S
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2390
Practice Address - Country:US
Practice Address - Phone:315-786-3990
Practice Address - Fax:315-786-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty