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General NPI Number Information
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NPI Number | 1255777348
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Entity Type | Organization
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Legal Business Name | BIDERMAN DENTAL PC
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 90-19 157 AVE.
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City | HOWARD BEACH
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State | NY
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Zip | 11414
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Country | US
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Telephone | 718-843-9209
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Fax | 718-843-4140
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Provider Business Mailing Address
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Address Line | 9019 157TH AVE
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City | HOWARD BEACH
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State | NY
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Zip | 11414-2739
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Country | US
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Telephone | 718-843-9209
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Fax | 718-843-4140
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRA BIDERMAN
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Credential |
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Telephone | 718-843-9209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 034379
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License Number State | NY
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