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General NPI Number Information
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NPI Number | 1730762642
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF BORO PARK PLLC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1526 50TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-3745
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Country | US
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Telephone | 718-854-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HALYARD RD
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City | VALLEY STREAM
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State | NY
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Zip | 11581-2813
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DR/OWNER
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Name | SHALOM BLOBSTEIN
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Credential | DMD
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Telephone | 917-450-4990
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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