Healthcare Provider Details

I. General information

NPI: 1952265753
Provider Name (Legal Business Name): ITD HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 57TH ST STE 1420
NEW YORK NY
10019-2401
US

IV. Provider business mailing address

92 HORATIO ST APT 3S
NEW YORK NY
10014-1663
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-5749
  • Fax: 212-307-7309
Mailing address:
  • Phone: 917-774-3777
  • Fax: 212-307-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ISAAC BAR
Title or Position: DENTIST
Credential:
Phone: 917-774-3777