=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265714042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IOD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 09/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10505 69TH AVE SUITE 112A
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-830-0209
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10505 69TH AVE SUITE 112A
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-830-0209
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. IRA ORGEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-830-0209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 040486-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------