# LONG ISLAND ORAL SURGERY ASSOCIATES, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LONG ISLAND ORAL SURGERY ASSOCIATES, PC
- **Other names:** Long Island Center for Oral and Maxillofacial Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306201066
- **Legal business name:** LONG ISLAND ORAL SURGERY ASSOCIATES, PC
- **Authorized official:** MRS. KATHY LARSON (OFFICE MANAGER)
- **Authorized official phone:** (516) 487-4100

## Contact information

- **Practice address:** 1000 NORTHERN BLVD, SUITE 180, GREAT NECK, NY 11021-5338
- **Practice address phone:** (516) 487-4100
- **Practice address fax:** (516) 487-4041
- **Mailing address:** 959 BRUSH HOLLOW RD, SUITE 102, WESTBURY, NY 11590-1778
- **Mailing address phone:** (516) 333-5900
- **Mailing address fax:** (516) 333-5868

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 041527 | NY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 044656 | NY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 052978 | NY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 057517-1 | NY | — |

## Other

- **Enumeration date:** 12/23/2015
- **Last updated:** 12/23/2015