1740626266 NPI number — DOWNTOWN DENTAL P.C.

Table of content: (NPI 1740626266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740626266 NPI number — DOWNTOWN DENTAL P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOWNTOWN DENTAL 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:
1740626266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9919 66TH RD
Provider Second Line Business Mailing Address:
APT # 3 A
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-4458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-203-1611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 MAIN ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06604-4221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-203-1611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
AMINOV
Authorized Official First Name:
YULIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-203-1611

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  010859 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008042136 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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