MEDICARE: GREGORY TYORKIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	039107	NY

General Provider Information

NPI Number	:	1013195205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY TYORKIN DDS

Provider Business Mailing Address
First Line	:	333 E 46TH ST
Second Line	:	SUITE #1A
City	:	NEW YORK
State	:	NY
Zip	:	10017-7401
Country	:	US
Telephone Number	:	212-697-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E 46TH ST
Second Line	:	SUITE #1A
City	:	NEW YORK
State	:	NY
Zip	:	10017-7401
Country	:	US
Telephone Number	:	212-697-7718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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