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General NPI Number Information
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NPI Number | 1962877845
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Entity Type | Organization
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Legal Business Name | EAST HARLEM DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1040 1ST AVE #393
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City | NEW YORK
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State | NY
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Zip | 10022-2991
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Country | US
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Telephone | 917-991-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E 104TH ST
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City | NEW YORK
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State | NY
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Zip | 10029-5418
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Country | US
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Telephone | 212-348-5492
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Fax | 212-828-0905
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Authorized Official
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Title or Position | OWNER
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Name | ERIC BERNSTEIN
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Credential | DDS
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Telephone | 917-817-3860
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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 | 050960
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License Number State | NY
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