Healthcare Provider Details

I. General information

NPI: 1104818566
Provider Name (Legal Business Name): ORTHODONTIC CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HEMPSTEAD TPKE SUITE 4
BETHPAGE NY
11714-5711
US

IV. Provider business mailing address

4250 HEMPSTEAD TPKE SUITE 4
BETHPAGE NY
11714-5711
US

V. Phone/Fax

Practice location:
  • Phone: 516-579-8950
  • Fax: 516-579-0092
Mailing address:
  • Phone: 516-579-8950
  • Fax: 516-579-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number034155
License Number StateNY

VIII. Authorized Official

Name: DR. HARVEY M CHOIT
Title or Position: VP/SEC
Credential: D.M.D.
Phone: 516-579-8950