Healthcare Provider Details

I. General information

NPI: 1306361696
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES AT HANSON PLACE, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MONTAGUE ST FL 9
BROOKLYN NY
11201-3608
US

IV. Provider business mailing address

185 MONTAGUE ST FL 9
BROOKLYN NY
11201-3608
US

V. Phone/Fax

Practice location:
  • Phone: 718-638-5100
  • Fax: 718-638-5190
Mailing address:
  • Phone: 718-638-5100
  • Fax: 718-638-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number036742
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT STEVEN GOLDBERGER
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-638-5100