Provider Demographics
NPI:1730329301
Name:GREENWICH ORAL AND MAXILLOFACIAL SURGERY ASSOC.
Entity type:Organization
Organization Name:GREENWICH ORAL AND MAXILLOFACIAL SURGERY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-253-9088
Mailing Address - Street 1:14 RYE RIDGE PLAZA
Mailing Address - Street 2:SUITE 234
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-253-9088
Mailing Address - Fax:914-253-4925
Practice Address - Street 1:14 RYE RIDGE PLAZA
Practice Address - Street 2:SUITE 234
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-253-9088
Practice Address - Fax:914-253-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD2E941Medicare PIN
NYT22384Medicare UPIN