Healthcare Provider Details

I. General information

NPI: 1588800759
Provider Name (Legal Business Name): CHAMBERS STREET ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 CHAMBERS ST FRNT 101
NEW YORK NY
10007-2051
US

IV. Provider business mailing address

88 CHAMBERS ST FRNT 101
NEW YORK NY
10007-2051
US

V. Phone/Fax

Practice location:
  • Phone: 212-233-8320
  • Fax:
Mailing address:
  • Phone: 212-233-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0469571
License Number StateNY

VIII. Authorized Official

Name: DR. KENNETH B. COOPERMAN
Title or Position: OWNER
Credential: DMD
Phone: 212-233-8320