=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619098175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY BELOK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 EAST 55TH STREET #301
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-753-6740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 EAST 55TH STREET #301
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-753-6740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GREGORY BELOK
-----------------------------------------------------
Credential | D.D.S.,M.P.H.
-----------------------------------------------------
Telephone | 201-461-0618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 029042
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------