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General NPI Number Information
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NPI Number | 1043632318
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL OF STATEN ISLAND,PC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 2291 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6625
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Country | US
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Telephone | 718-370-1200
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Fax | 718-370-1207
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Provider Business Mailing Address
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Address Line | 2291 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6625
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Country | US
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Telephone | 718-370-1200
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Fax | 718-370-1207
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN R ACKER
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Credential | DDS
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Telephone | 718-370-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 036474
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License Number State | NY
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