Healthcare Provider Details

I. General information

NPI: 1699154351
Provider Name (Legal Business Name): OKUN ORTHODONTICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RYE RIDGE PLZ SUITE 243
RYE BROOK NY
10573-2826
US

IV. Provider business mailing address

14 RYE RIDGE PLZ SUITE 243
RYE BROOK NY
10573-2826
US

V. Phone/Fax

Practice location:
  • Phone: 914-253-0722
  • Fax: 914-253-0723
Mailing address:
  • Phone: 914-253-0722
  • Fax: 914-253-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040546
License Number StateNY

VIII. Authorized Official

Name: DR. JUDITH ANNE OKUN
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 914-253-0722