Healthcare Provider Details

I. General information

NPI: 1659842870
Provider Name (Legal Business Name): CARNEGIE HILL 91ST ST DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 91ST ST STE A
NEW YORK NY
10128-0648
US

IV. Provider business mailing address

15 E 91ST ST STE A
NEW YORK NY
10128-0648
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-6475
  • Fax:
Mailing address:
  • Phone: 212-876-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SINH THI TA
Title or Position: OWNER
Credential: DDS
Phone: 212-876-6475