Healthcare Provider Details

I. General information

NPI: 1225388127
Provider Name (Legal Business Name): NEWBURGH DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 S PLANK RD
NEWBURGH NY
12550-3901
US

IV. Provider business mailing address

31 S PLANK RD
NEWBURGH NY
12550-3901
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-2140
  • Fax: 845-565-2229
Mailing address:
  • Phone: 845-565-2140
  • Fax: 845-565-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number52858
License Number StateNY

VIII. Authorized Official

Name: DR. MARA PAIGE ROSENBERG
Title or Position: PARTNER
Credential: DDS
Phone: 646-320-8247