Individual
NEAL J EZRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1229 BROADWAY, SUITE 207, HEWLETT, NY 11557
(516) 374-2215
(516) 374-9046
Mailing address
1301 CORNAGA AVE, FAR ROCKAWAY, NY 11691
(718) 327-6592
(718) 471-9133
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
040873
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01406275
—
NY
Enumeration date
05/02/2007
Last updated
07/08/2007
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