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General NPI Number Information
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NPI Number | 1407670649
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Entity Type | Individual
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Provider Name | RAJ SHETH
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 726 BROADWAY STE 350
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City | NEW YORK
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State | NY
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Zip | 10003-9616
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Country | US
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Telephone | 212-443-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 338 E 83RD ST APT 1D
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City | NEW YORK
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State | NY
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Zip | 10028-4270
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Country | US
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Telephone | 817-808-8439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 029-367
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License Number State | NY
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