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Organization
ORAL RECONSTRUCTIVE JAW SURGERY PC
Active
Organization
ORAL RECONSTRUCTIVE JAW SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY CHARLES CHOTKOWKI D.M.D (MEDICAL DIRECTOR)
(212) 838-0090
Entity
Organization
Contact information
Practice address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
(212) 935-1296
Mailing address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
(212) 935-1296
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
440777
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440777
THE JOINT COMMISSION
NY
Enumeration date
03/02/2015
Last updated
03/02/2015
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