Healthcare Provider Details

I. General information

NPI: 1962021097
Provider Name (Legal Business Name): ADEENA CHEFITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPRING VALLEY MARKET PL
SPRING VALLEY NY
10977-5210
US

IV. Provider business mailing address

51 DANA PL
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 845-352-2100
  • Fax:
Mailing address:
  • Phone: 914-980-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number061935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: