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General NPI Number Information
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NPI Number | 1396958922
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Entity Type | Organization
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Legal Business Name | DR. EMMANUELA MENA DENTIST , P.C.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 801 W 181ST ST APT 9
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City | NEW YORK
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State | NY
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Zip | 10033-4518
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Country | US
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Telephone | 212-740-4040
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Fax | 212-740-1155
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Provider Business Mailing Address
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Address Line | 801 W 181ST ST APT 9
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City | NEW YORK
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State | NY
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Zip | 10033-4518
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Country | US
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Telephone | 212-740-4040
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Fax | 212-740-1155
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | ANNY FLORIAN
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Credential |
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Telephone | 212-740-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 042603
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License Number State | NY
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