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General NPI Number Information
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NPI Number | 1952443442
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Entity Type | Organization
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Legal Business Name | ASTORIA MODERN FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3156 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3909
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Country | US
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Telephone | 718-721-4700
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Fax | 718-204-5641
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Provider Business Mailing Address
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Address Line | 3156 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3909
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Country | US
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Telephone | 718-721-4700
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Fax | 718-204-5641
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JAMES R GELFAND
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Credential | DDS
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Telephone | 718-721-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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