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General NPI Number Information
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NPI Number | 1609948082
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Entity Type | Organization
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Legal Business Name | KNICKERBOCKER DENTAL GROUP
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 121 EAST 60TH ST #10B
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-752-7188
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Fax | 212-583-0366
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Provider Business Mailing Address
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Address Line | 121 EAST 60TH ST #10B
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-752-7188
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Fax | 212-583-0366
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT L CASTELLANO
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Credential | DDS
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Telephone | 212-752-7188
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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