Healthcare Provider Details

I. General information

NPI: 1104105907
Provider Name (Legal Business Name): THEODORE SEWITCH D.M.D. M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EAST 56TH STREET 5TH FLOOR
NEW YORK NY
10022
US

IV. Provider business mailing address

60 EAST 56TH STREET 5TH FLOOR
NEW YORK NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-7672
  • Fax: 212-758-6822
Mailing address:
  • Phone: 212-753-7672
  • Fax: 212-758-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: