Healthcare Provider Details

I. General information

NPI: 1477228971
Provider Name (Legal Business Name): ST. BARNABAS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE DENTAL DEPARTMENT
BRONX NY
10457
US

IV. Provider business mailing address

4422 3RD AVE DENTAL DEPARTMENT
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6839
  • Fax: 718-960-3663
Mailing address:
  • Phone: 718-960-9000
  • Fax: 718-960-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ARUN SHARMA
Title or Position: VP OF REVENUE CYCLE
Credential:
Phone: 718-960-3842