MEDICARE: PROSTHODONTIC ASSOCIATES OF NY, 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	1223P0700X	Prosthodontics	023996	NY

General Provider Information

NPI Number	:	1093848624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHODONTIC ASSOCIATES OF NY, PC

Provider Business Mailing Address
First Line	:	60 E 42ND ST
Second Line	:	SUITE 1656
City	:	NEW YORK
State	:	NY
Zip	:	10165-0006
Country	:	US
Telephone Number	:	212-986-4839
Fax Number	:	212-986-4927

Provider Business Practice Location Address
First Line	:	60 E 42ND ST
Second Line	:	SUITE 1656
City	:	NEW YORK
State	:	NY
Zip	:	10165-0006
Country	:	US
Telephone Number	:	212-986-4839
Fax Number	:	212-986-4927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOEL GOLDIN
Credential	:	DMD
Telephone Number	:	212-986-4830

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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