MEDICARE: NG DENTAL GALLERY

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	050360-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427295062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NG DENTAL GALLERY

Provider Business Mailing Address
First Line	:	2027 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-2858
Country	:	US
Telephone Number	:	212-828-4200
Fax Number	:	212-828-7649

Provider Business Practice Location Address
First Line	:	2027 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-2858
Country	:	US
Telephone Number	:	212-828-4200
Fax Number	:	212-828-7649

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. NATALIE GOR
Credential	:	D.D.S.
Telephone Number	:	212-828-4200

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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Directions to “NG DENTAL GALLERY ” Practice Location

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