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General NPI Number Information
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NPI Number | 1588007140
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Entity Type | Organization
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Legal Business Name | BRACETOWN ORTHODONTICS,LLP
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Dates
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Enumeration Date | 04/14/2013
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Last Update Date | 04/14/2013
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Provider Practice Location Address
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Address Line | 3119 NEWTOWN AVE SUITE 201
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City | ASTORIA
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State | NY
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Zip | 11102-1350
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Country | US
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Telephone | 718-721-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 3119 NEWTOWN AVE SUITE 201
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City | ASTORIA
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State | NY
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Zip | 11102-1350
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Country | US
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Telephone | 718-721-5100
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | SCOTT FRIEDMAN
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Credential | DDS
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Telephone | 718-721-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 34366
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License Number State | NY
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