=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376830927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NYC PEDIATRIC DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2011
-----------------------------------------------------
Last Update Date | 07/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2022 LEXINGTON AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10035-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-987-0777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2022 LEXINGTON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10035-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. RASHMI AMBEWADIKAR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-987-0777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 052076
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------