Healthcare Provider Details

I. General information

NPI: 1922149962
Provider Name (Legal Business Name): COORDINATED DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE SUITE 1225
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE SUITE 1225
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-888-3159
  • Fax:
Mailing address:
  • Phone: 212-888-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number050064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number024608
License Number StateNY

VIII. Authorized Official

Name: DR. GERALD K APPELLE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 212-888-3159