=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629169925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL R. SZABATURA DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-753-7400
-----------------------------------------------------
Fax | 212-753-7402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 MADISON AVE 15FL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-753-7400
-----------------------------------------------------
Fax | 212-753-7402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | DR. MICHAEL R. SZABATURA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-753-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 036789
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------