Healthcare Provider Details

I. General information

NPI: 1992859938
Provider Name (Legal Business Name): ELLIOTT OSTRO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CENTRAL PARK S SUITE 2C
NEW YORK NY
10019-1628
US

IV. Provider business mailing address

30 CENTRAL PARK S RM 6D
NEW YORK NY
10019-1628
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-8311
  • Fax:
Mailing address:
  • Phone: 212-223-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049241-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: