Healthcare Provider Details

I. General information

NPI: 1578244422
Provider Name (Legal Business Name): BRONX WELLNESS FAMILY DENTAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 CROTONA PKWY FL 5A
BRONX NY
10460-1526
US

IV. Provider business mailing address

65 WARWICK RD
GREAT NECK NY
11023-1667
US

V. Phone/Fax

Practice location:
  • Phone: 516-660-6343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ARVIN ELYASI
Title or Position: PRESIDENT
Credential: DDS
Phone: 516-660-6343