1740604131 NPI number — GREENWICH VILLAGE DENTAL ARTS PC

Table of content: (NPI 1740604131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740604131 NPI number — GREENWICH VILLAGE DENTAL ARTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWICH VILLAGE DENTAL ARTS 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:
ADVANCED DENTAL ARTS
Provider Other Organization Name Type Code:
3
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:
1740604131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E 9TH ST
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:
10003-6311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-388-1170
Provider Business Mailing Address Fax Number:
212-388-1181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 EAST 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-388-1170
Provider Business Practice Location Address Fax Number:
212-388-1181
Provider Enumeration Date:
02/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BERTMAN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-388-1170

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  048272 , 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: 048272 . This is a "DENTIST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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