=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114274990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NY PEDIATRIC DENTAL CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2012
-----------------------------------------------------
Last Update Date | 08/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2519 30TH DR 1L
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-932-1951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2519 30TH DR 1L
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-932-1951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. LUMINITA A. SCHIOP
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 718-932-1951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 050638
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------