=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851547905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN F. BERDAN, D.M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2008
-----------------------------------------------------
Last Update Date | 08/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 CENTRAL PARK SOUTH SUITE 11C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-702-8675
-----------------------------------------------------
Fax | 212-702-8676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 CENTRAL PARK SOUTH SUITE 11C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-702-8675
-----------------------------------------------------
Fax | 212-702-8676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAN FRANCIS BERDAN
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 212-702-8675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 0405091
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------