MEDICARE: JB DENTAL PC

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	051014	NY
2	1223G0001X	General Practice Dentistry	036193	NY

General Provider Information

NPI Number	:	1053582106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JB DENTAL PC

Provider Business Mailing Address
First Line	:	3410 BROADWAY
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10031-7400
Country	:	US
Telephone Number	:	212-283-7670
Fax Number	:	212-283-7832

Provider Business Practice Location Address
First Line	:	3410 BROADWAY
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10031-7400
Country	:	US
Telephone Number	:	212-283-7670
Fax Number	:	212-283-7832

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. SHARONE RACHAL MARCUS
Credential	:
Telephone Number	:	917-968-7023

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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Directions to “JB DENTAL PC ” Practice Location

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