Healthcare Provider Details

I. General information

NPI: 1750489563
Provider Name (Legal Business Name): 42ND STREET DENTAL ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 42ND ST FIFTH FLOOR
NEW YORK NY
10017-5678
US

IV. Provider business mailing address

120 E 42ND ST FIFTH FLOOR
NEW YORK NY
10017-5678
US

V. Phone/Fax

Practice location:
  • Phone: 212-867-8862
  • Fax: 212-867-8402
Mailing address:
  • Phone: 212-867-8862
  • Fax: 212-867-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number050453
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number047883-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number048686
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number052345-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number051796-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number040690
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number044327
License Number StateNY

VIII. Authorized Official

Name: DR. MARK S NADOLNE
Title or Position: PARTNER
Credential: D.M.D.
Phone: 212-867-8862