Healthcare Provider Details

I. General information

NPI: 1740738798
Provider Name (Legal Business Name): VARDY ORTHODONTICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 78TH ST STE B
NEW YORK NY
10024-6728
US

IV. Provider business mailing address

130 W 78TH ST STE B
NEW YORK NY
10024-6728
US

V. Phone/Fax

Practice location:
  • Phone: 212-579-6881
  • Fax: 212-579-6871
Mailing address:
  • Phone: 212-579-6881
  • Fax: 212-579-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number043539
License Number StateNY

VIII. Authorized Official

Name: DR. IRIS H VARDY
Title or Position: PRESIDENT
Credential: DDS
Phone: 212-579-6881