Healthcare Provider Details

I. General information

NPI: 1063673143
Provider Name (Legal Business Name): GEDALYA RAPOPORT, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PARK DR
POMONA NY
10970-3516
US

IV. Provider business mailing address

8 MEDICAL PARK DR
POMONA NY
10970-3516
US

V. Phone/Fax

Practice location:
  • Phone: 845-517-2358
  • Fax: 845-517-2359
Mailing address:
  • Phone: 845-517-2358
  • Fax: 845-517-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEANA RAPOPORT
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-517-2358