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General NPI Number Information
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NPI Number | 1306201462
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Entity Type | Organization
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Legal Business Name | MARK M. BORNSTEIN, DDS, PLLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 145 MAPLE AVE
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City | CEDARHURST
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State | NY
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Zip | 11516-2225
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Country | US
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Telephone | 516-295-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 145 MAPLE AVE
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City | CEDARHURST
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State | NY
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Zip | 11516-2225
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Country | US
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Telephone | 516-295-0081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK M BORNSTEIN
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Credential |
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Telephone | 516-295-0081
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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 | 052254
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License Number State | NY
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