Organization
PARK EAST ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SETH MARTIN BLACK DDS (OWNER)
(212) 593-2930
Entity
Organization
Contact information
Practice address
521 PARK AVE, NEW YORK, NY 10065-8140
(212) 593-2930
(212) 593-2931
Mailing address
521 PARK AVE, NEW YORK, NY 10065-8140
(212) 593-2930
(212) 593-2931
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
033118
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0707035
—
NY
Enumeration date
09/15/2012
Last updated
09/15/2012
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