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General NPI Number Information
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NPI Number | 1811130750
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Entity Type | Organization
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Legal Business Name | QUEENS PERIODONTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 9354 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-1149
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Country | US
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Telephone | 718-275-6262
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Fax | 718-275-6338
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Provider Business Mailing Address
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Address Line | 9354 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-1149
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Country | US
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Telephone | 718-275-6262
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Fax | 718-275-6338
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN CHADROFF
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Credential | D.D.S
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Telephone | 718-275-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 040050
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License Number State | NY
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