Healthcare Provider Details

I. General information

NPI: 1649551433
Provider Name (Legal Business Name): QUEENS COUNTY ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24208 HILLSIDE AVE
BELLEROSE NY
11426-1336
US

IV. Provider business mailing address

24208 HILLSIDE AVE
BELLEROSE NY
11426-1336
US

V. Phone/Fax

Practice location:
  • Phone: 718-412-0945
  • Fax: 917-387-8695
Mailing address:
  • Phone: 718-412-0945
  • Fax: 917-387-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL J COLLURA
Title or Position: OWNER
Credential:
Phone: 631-462-4600