MEDICARE: DR. RITU DUREJA D.D.S

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	1223G0001X	General Practice Dentistry	048816	NY
2	1223G0001X	General Practice Dentistry	22DJ02307100	NJ

General Provider Information

NPI Number	:	1053321430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITU DUREJA D.D.S

Provider Business Mailing Address
First Line	:	225 LEE AVE
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-5845
Country	:	US
Telephone Number	:	516-987-7959
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 GRAHAM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4008
Country	:	US
Telephone Number	:	718-218-6600
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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