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General NPI Number Information
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NPI Number | 1740700582
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Entity Type | Organization
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Legal Business Name | EAST 19TH STREET DENTAL
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 118 E 19TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-2127
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Country | US
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Telephone | 212-979-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 118 E 19TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-2127
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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 | OWNER
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Name | DAVID JANASH
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Credential |
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Telephone | 917-915-4504
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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 | 051610
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 051610
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License Number State | NY
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