Healthcare Provider Details

I. General information

NPI: 1598774671
Provider Name (Legal Business Name): EMILLE M AGRAIT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 60TH ST SUITE 905
NEW YORK NY
10022-1008
US

IV. Provider business mailing address

100 JANE ST APT. 7H
NEW YORK NY
10014-1735
US

V. Phone/Fax

Practice location:
  • Phone: 212-421-5781
  • Fax: 212-421-9261
Mailing address:
  • Phone: 646-420-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number051455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: