1760905954 NPI number — MANHATTAN DENTAL STUDIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760905954 NPI number — MANHATTAN DENTAL STUDIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANHATTAN DENTAL STUDIO
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:
1760905954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
358 5TH AVE RM 1005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-2209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-685-2476
Provider Business Mailing Address Fax Number:
212-947-2826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
358 FIFTH AVE
Provider Second Line Business Practice Location Address:
SUITE 1005
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-685-2476
Provider Business Practice Location Address Fax Number:
212-947-2826
Provider Enumeration Date:
07/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TOMACK
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-685-2476

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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)





Copyright © 2007-2025 www.npivalidator.com