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NPI Code Detail

MEDICARE: PCO ORTHO LLC

MEDICARE: PCO ORTHO LLC
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
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1376177782
Entity Type Code : Organization
Provider Name (Legal Business Name) : PCO ORTHO LLC
Provider Business Mailing Address
First Line : 301 E 22ND ST APT 9M
Second Line :
City : NEW YORK
State : NY
Zip : 10010-4821
Country : US
Telephone Number : 646-496-6696
Fax Number :
Provider Business Practice Location Address
First Line : 3422 35TH ST
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11106-1268
Country : US
Telephone Number : 646-496-6696
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : DR. TATIYA UNGPHAKORN
Credential : DDS
Telephone Number : 646-496-6696
Provider Enumeration Date : 02/24/2020
Last Update Date : 02/24/2020

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Directions to “PCO ORTHO LLC ” Practice Location

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