=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396833570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART J FROUM DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 WEST 54TH STREET SUITE I CD
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-586-4209
-----------------------------------------------------
Fax | 212-246-7599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 WEST 54TH STREET SUITE I CD
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-586-4209
-----------------------------------------------------
Fax | 212-246-7599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF CORPORATION
-----------------------------------------------------
Name | DR. STUART J FROUM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-586-4209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 028454
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------