Healthcare Provider Details

I. General information

NPI: 1215745203
Provider Name (Legal Business Name): MARC NARDEA DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 5TH AVE RM 1210
NEW YORK NY
10016-5025
US

IV. Provider business mailing address

347 5TH AVE RM 1210
NEW YORK NY
10016-5025
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-4845
  • Fax:
Mailing address:
  • Phone: 908-309-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARC NARDEA
Title or Position: OWNER AND PEDIATRIC DENTIST
Credential: DMD
Phone: 908-309-4845