=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083821599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODOLFO SANCHEZ D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 E 58TH ST SUITE 3200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10155-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-752-7937
-----------------------------------------------------
Fax | 212-754-6753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 E 58TH ST SUITE 3200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10155-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-752-7937
-----------------------------------------------------
Fax | 212-754-6753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 047145
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------