1245334564 NPI number — LDFCB DENTISTRY

Table of content: (NPI 1245334564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245334564 NPI number — LDFCB DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LDFCB DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC DENTISTRY OF BRONX
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245334564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 N AIRMONT RD STE 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFERN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-369-3703
Provider Business Mailing Address Fax Number:
945-369-3183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-367-7645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBSON
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-369-3703

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 045485 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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