Healthcare Provider Details

I. General information

NPI: 1841645819
Provider Name (Legal Business Name): RIVERDALE COMPREHENSIVE DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NETHERLAND AVE SUITE 117
BRONX NY
10463-4801
US

IV. Provider business mailing address

2600 NETHERLAND AVE SUITE 117
BRONX NY
10463-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-549-3910
  • Fax:
Mailing address:
  • Phone: 718-549-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049729
License Number StateNY

VIII. Authorized Official

Name: DR. RACHNA BAJAJ
Title or Position: MANAGER/MEMBER
Credential: DDS
Phone: 718-549-3910