Healthcare Provider Details

I. General information

NPI: 1073940656
Provider Name (Legal Business Name): PRADIP R. SHETYE, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 EAST 33TH STREET LOWER LEVEL
NEW YORK NY
10016
US

IV. Provider business mailing address

333 EAST 30TH STREET APT 1H
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5204
  • Fax: 212-263-0882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number055911
License Number StateNY

VIII. Authorized Official

Name: PRADIP SHETYE
Title or Position: PRESIDENT
Credential: DDS, MDS
Phone: 917-553-0349