Healthcare Provider Details

I. General information

NPI: 1194332932
Provider Name (Legal Business Name): 28TH AND MADISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MADISON AVE
NEW YORK NY
10016-8724
US

IV. Provider business mailing address

212 W 18TH ST APT 9F
NEW YORK NY
10011-4554
US

V. Phone/Fax

Practice location:
  • Phone: 646-770-2091
  • Fax:
Mailing address:
  • Phone: 708-307-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. COURTNEY AUDRA SCHIEFELBEIIN
Title or Position: OWNER
Credential: DMD
Phone: 646-770-2091