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General NPI Number Information
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NPI Number | 1770908287
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Entity Type | Individual
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Provider Name | KEREN ETZION
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 192 E 75TH ST KEREN ETZION C/O SMILES 4 KIDS
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City | NEW YORK
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State | NY
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Zip | 10021-3242
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Country | US
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Telephone | 516-978-8728
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Fax |
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Provider Business Mailing Address
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Address Line | 30 W 63RD ST APT 8B
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City | NEW YORK
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State | NY
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Zip | 10023-7103
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Country | US
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Telephone | 516-978-8728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 058726
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License Number State | NY
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