Healthcare Provider Details

I. General information

NPI: 1356464895
Provider Name (Legal Business Name): ALLAN S. DEUTSCH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST SUITE 308
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

133 E 58TH ST SUITE 308
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-2011
  • Fax: 212-838-0486
Mailing address:
  • Phone: 212-838-2011
  • Fax: 212-838-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number030140-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: