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General NPI Number Information
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NPI Number | 1063673143
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Entity Type | Organization
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Legal Business Name | GEDALYA RAPOPORT, DMD, PLLC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 8 MEDICAL PARK DR
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City | POMONA
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State | NY
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Zip | 10970-3516
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Country | US
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Telephone | 845-517-2358
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Fax | 845-517-2359
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Provider Business Mailing Address
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Address Line | 8 MEDICAL PARK DR
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City | POMONA
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State | NY
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Zip | 10970-3516
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Country | US
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Telephone | 845-517-2358
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Fax | 845-517-2359
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LEANA RAPOPORT
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Credential |
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Telephone | 845-517-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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