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General NPI Number Information
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NPI Number | 1780101212
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Entity Type | Organization
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Legal Business Name | RANDY ZULTOWSKY DDS, P.C.
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 315 W 70TH ST
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City | NEW YORK
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State | NY
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Zip | 10023-3504
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Country | US
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Telephone | 917-952-5642
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Fax |
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Provider Business Mailing Address
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Address Line | 11 W 69TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10023-4700
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Country | US
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Telephone | 917-952-5642
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY ZULTOWSKY
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Credential | DDS
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Telephone | 917-952-5642
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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 | 055100
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License Number State | NY
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