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General NPI Number Information
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NPI Number | 1619460003
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Entity Type | Organization
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Legal Business Name | MANHATTAN MIDTOWN DENTAL PC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 30 E 60TH ST STE 1201
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City | NEW YORK
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State | NY
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Zip | 10022-1142
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Country | US
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Telephone | 212-838-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E 60TH ST STE 1201
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City | NEW YORK
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State | NY
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Zip | 10022-1142
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Country | US
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Telephone | 212-838-2900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DR.MICHAEL KROCHAK
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Credential | DMD
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Telephone | 212-838-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 037027
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License Number State | NY
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