Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 049902 | NY |
NPI | 1093754467 |
---|---|
Provider Name | Ross Oran Chavkin |
First Address | Melville, NY 11747-4713 |
Second Address | Melville, NY 11747-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 15/10/2014 |