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General NPI Number Information
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NPI Number | 1659657294
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Entity Type | Organization
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Legal Business Name | EAST VILLAGE DENTAL PC
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 15 AVENUE A GROUND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10009-7996
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Country | US
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Telephone | 212-677-2510
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Fax | 212-228-8119
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Provider Business Mailing Address
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Address Line | 15 AVENUE A GROUND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10009-7996
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Country | US
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Telephone | 212-677-2510
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Fax | 212-228-8119
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Authorized Official
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Title or Position | OWNER
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Name | LANA ROZENBERG
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Credential |
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Telephone | 212-677-2510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 045553-1
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License Number State | NY
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