Healthcare Provider Details

I. General information

NPI: 1841297058
Provider Name (Legal Business Name): MARC W MICHALOWICZ D.D.S., M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/18/2023
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA UNIVERSITY, COLLEGE OF DENTAL MEDICINE 630 W 168TH ST SUITE VC7-226
NEW YORK NY
10032-1003
US

IV. Provider business mailing address

630 W 168TH ST # 20
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-0424
  • Fax: 845-786-4938
Mailing address:
  • Phone: 212-305-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number037936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: