MEDICARE: ASTORIA MODERN FAMILY DENTAL PLLC

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

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	:	1952443442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTORIA MODERN FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	3156 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3909
Country	:	US
Telephone Number	:	718-721-4700
Fax Number	:	718-204-5641

Provider Business Practice Location Address
First Line	:	3156 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3909
Country	:	US
Telephone Number	:	718-721-4700
Fax Number	:	718-204-5641

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JAMES R GELFAND
Credential	:	DDS
Telephone Number	:	718-721-4700

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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