Healthcare Provider Details

I. General information

NPI: 1689309171
Provider Name (Legal Business Name): NYC HEALTH AND HOSPITALS LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

210 E 47TH ST APT 3E
NEW YORK NY
10017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5690
  • 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: DEJON SKENDO
Title or Position: GME COORDINATING MANAGER - DENTAL
Credential:
Phone: 718-579-5692