1215028428 NPI number — DENTAL ARTS AT LEXINGTON & 63RD ST PC

Table of content: (NPI 1215028428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215028428 NPI number — DENTAL ARTS AT LEXINGTON & 63RD ST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL ARTS AT LEXINGTON & 63RD ST 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:
1215028428
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:
105 E 63RD ST
Provider Second Line Business Mailing Address:
SUITE 1A-1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-581-3030
Provider Business Mailing Address Fax Number:
212-207-8521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E 63RD ST
Provider Second Line Business Practice Location Address:
SUITE 1A-1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-581-3030
Provider Business Practice Location Address Fax Number:
212-207-8521
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORADA
Authorized Official First Name:
CHARITO
Authorized Official Middle Name:
DELA CRUZ
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
212-581-3030

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0432701 , 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