Healthcare Provider Details

I. General information

NPI: 1831638840
Provider Name (Legal Business Name): WASHINGTON HEIGHTS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 15TH ST SUITE PRB
NEW YORK NY
10003-3902
US

IV. Provider business mailing address

200 E 15TH ST SUITE PRB
NEW YORK NY
10003-3902
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-9177
  • Fax: 212-777-9178
Mailing address:
  • Phone: 212-777-9177
  • Fax: 212-777-9178

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. JASON BERK
Title or Position: OWNER
Credential: DDS
Phone: 212-777-9177