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General NPI Number Information
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NPI Number | 1649424045
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Entity Type | Organization
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Legal Business Name | 4290 WASHINGTON HEIGHTS DENTAL
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 4290 BROADWAY # 2S
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City | NEW YORK
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State | NY
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Zip | 10033-3732
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Country | US
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Telephone | 212-781-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 4290 BROADWAY # 2S
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City | NEW YORK
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State | NY
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Zip | 10033-3732
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Country | US
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Telephone | 212-781-0166
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MOISE NAWLO
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Credential | DDS
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Telephone | 212-780-0166
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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 | 050606
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049809
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License Number State | NY
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