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General NPI Number Information
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NPI Number | 1366983660
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Entity Type | Organization
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Legal Business Name | JUAN C. JARAMILLO D.D.S. P.C.
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 30 W 60TH ST SUITE # 1GH
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City | NEW YORK
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State | NY
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Zip | 10023-7902
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Country | US
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Telephone | 212-246-3200
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Fax | 212-246-3267
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Provider Business Mailing Address
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Address Line | 30 W 60TH ST SUITE # 1GH
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City | NEW YORK
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State | NY
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Zip | 10023-7902
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Country | US
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Telephone | 212-246-3200
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Fax | 212-246-3267
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Authorized Official
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Title or Position | CEO
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Name | DR. JUAN C JARAMILLO
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Credential | D.D.S.
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Telephone | 212-246-3200
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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 | 047921
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License Number State | NY
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