Healthcare Provider Details

I. General information

NPI: 1417091240
Provider Name (Legal Business Name): DAVID A ZADIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FREDERICK A STANGE III DDS

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 47TH ST SUITE 1D
NEW YORK NY
10017-2108
US

IV. Provider business mailing address

3 WOODSIDE DRIVE
GREENWICH CT
06830
US

V. Phone/Fax

Practice location:
  • Phone: 212-888-3570
  • Fax: 212-888-0506
Mailing address:
  • Phone: 203-869-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number040770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: