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General NPI Number Information
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NPI Number | 1588800759
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Entity Type | Organization
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Legal Business Name | CHAMBERS STREET ORTHODONTICS
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 88 CHAMBERS ST FRNT 101
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City | NEW YORK
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State | NY
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Zip | 10007-2051
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Country | US
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Telephone | 212-233-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 88 CHAMBERS ST FRNT 101
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City | NEW YORK
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State | NY
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Zip | 10007-2051
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Country | US
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Telephone | 212-233-8320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH B. COOPERMAN
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Credential | DMD
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Telephone | 212-233-8320
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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 | 0469571
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License Number State | NY
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