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General NPI Number Information
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NPI Number | 1578327466
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Entity Type | Organization
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Legal Business Name | AMITYVILLE ORTHODONTICS P.C.
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 18 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2726
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Country | US
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Telephone | 631-201-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 DOGWOOD LN
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City | WESTBURY
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State | NY
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Zip | 11590-6021
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Country | US
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Telephone | 516-660-7763
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | JUSTYNA BALICKA
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Credential | DDS
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Telephone | 516-805-4994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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