MEDICARE: DR. EMANUEL LAYLIEV D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	049730	NY
2	1223G0001X	General Practice Dentistry	049730	NY

General Provider Information

NPI Number	:	1154692655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMANUEL LAYLIEV D.D.S.

Provider Business Mailing Address
First Line	:	128 E 71ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-5014
Country	:	US
Telephone Number	:	212-288-4455
Fax Number	:	212-288-5260

Provider Business Practice Location Address
First Line	:	128 E 71ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-5014
Country	:	US
Telephone Number	:	212-288-4455
Fax Number	:	212-288-5260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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