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General NPI Number Information
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NPI Number | 1780332973
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Entity Type | Organization
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Legal Business Name | ONE ENDO SUPPORT SERVICES
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 515 HALSTEAD AVE
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City | MAMARONECK
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State | NY
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Zip | 10543-2715
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Country | US
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Telephone | 914-777-9465
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Fax | 914-777-9467
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Provider Business Mailing Address
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Address Line | 515 HALSTEAD AVE
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City | MAMARONECK
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State | NY
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Zip | 10543-2715
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Country | US
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Telephone | 914-777-9465
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | LORI MICELI
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Credential |
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Telephone | 914-777-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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