1033252317 NPI number — AP DENTAL CARE, PC

Table of content: (NPI 1033252317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033252317 NPI number — AP DENTAL CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AP DENTAL CARE, PC
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:
1033252317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6610 YELLOWSTONE BLVD
Provider Second Line Business Mailing Address:
APT #4A
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-795-5297
Provider Business Mailing Address Fax Number:
718-263-2657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6509 99TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-263-2040
Provider Business Practice Location Address Fax Number:
718-263-2657
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POLT
Authorized Official First Name:
ALBINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-263-2040

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  049084 , 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: 02117715 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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