=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356464895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLAN S. DEUTSCH D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 10/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 E 58TH ST SUITE 308
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-838-2011
-----------------------------------------------------
Fax | 212-838-0486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 E 58TH ST SUITE 308
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-838-2011
-----------------------------------------------------
Fax | 212-838-0486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 030140-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------