1497926257 NPI number — NY1DENTAL ASSOCIATED P.C.

Table of content: KARLA FRANCESCA HERMOZA RBT (NPI 1891543104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497926257 NPI number — NY1DENTAL ASSOCIATED P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY1DENTAL ASSOCIATED P.C.
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:
Provider Other Organization Name Type Code:
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:
1497926257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 CONEY ISLAND AVE
Provider Second Line Business Mailing Address:
DENTAL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-258-8222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 CONEY ISLAND AVE
Provider Second Line Business Practice Location Address:
DENTAL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-8222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PINKHASOV
Authorized Official First Name:
SEVIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-258-8222

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  047422 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01899343 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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