=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811645450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARBOR POINT AT PELHAM DENTAL, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4674 BOSTON POST RD
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803-3055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-738-1033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 WESTAGE BUSINESS CTR DR STE 233
-----------------------------------------------------
City | FISHKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12524-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-897-2097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ADAM SPOSATO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-208-1456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------