Healthcare Provider Details

I. General information

NPI: 1295068278
Provider Name (Legal Business Name): HUDSON RIVER ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RIVERSIDE BLVD DENTAL OFFICE
NEW YORK NY
10069-1001
US

IV. Provider business mailing address

220 RIVERSIDE BLVD DENTAL OFFICE
NEW YORK NY
10069-1001
US

V. Phone/Fax

Practice location:
  • Phone: 212-580-1140
  • Fax: 212-954-5583
Mailing address:
  • Phone: 212-580-1140
  • Fax: 212-954-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number050711
License Number StateNY

VIII. Authorized Official

Name: DR. SAJU MATHEW
Title or Position: OWNER/DOCTOR
Credential: D.D.S.
Phone: 212-580-1140