1356417000 NPI number — ORTHODONTIC ASSOCIATES OF HASBROUCK HEIGHTS PC

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 1356417000 NPI number — ORTHODONTIC ASSOCIATES OF HASBROUCK HEIGHTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTIC ASSOCIATES OF HASBROUCK HEIGHTS 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:
1356417000
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:
150 TERRACE AVENUE
Provider Second Line Business Mailing Address:
APT 1A
Provider Business Mailing Address City Name:
HASBROUCK HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-288-2368
Provider Business Mailing Address Fax Number:
201-288-2384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 TERRACE AVENUE
Provider Second Line Business Practice Location Address:
APT 1A
Provider Business Practice Location Address City Name:
HASBROUCK HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-288-2368
Provider Business Practice Location Address Fax Number:
201-288-2384
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORKOWITZ
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-288-2368

Provider Taxonomy Codes

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

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





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