Organization
MICHAEL Y IVRY DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL YEHUDA IVRY DDS (OWNER)
(631) 252-2076
Entity
Organization
Contact information
Practice address
2550 SEAGIRT BLVD, FAR ROCKAWAY, NY 11691
(718) 327-2147
Mailing address
499 5TH AVE, CEDARHURST, NY 11516-1538
(631) 252-2076
(516) 596-7455
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
047962
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154509503
—
NY
Enumeration date
05/30/2018
Last updated
05/30/2018
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