Healthcare Provider Details

I. General information

NPI: 1275793317
Provider Name (Legal Business Name): GREGORY J HASKIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4571 KINGS HWY
BROOKLYN NY
11234-2025
US

IV. Provider business mailing address

4571 KINGS HWY
BROOKLYN NY
11234-2025
US

V. Phone/Fax

Practice location:
  • Phone: 718-692-4791
  • Fax: 718-692-3362
Mailing address:
  • Phone: 718-692-4791
  • Fax: 718-692-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0399641
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0399641
License Number StateNY

VIII. Authorized Official

Name: DR. GREGORY JEROME HASKIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-692-4791