MEDICARE: A SEAVIEW DENAL ASSOCIATES 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	305R00000X	Preferred Provider Organization	049030	NY

General Provider Information

NPI Number	:	1285813220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SEAVIEW DENAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	4528 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5220
Country	:	US
Telephone Number	:	718-937-5400
Fax Number	:	718-937-5772

Provider Business Practice Location Address
First Line	:	4528 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5220
Country	:	US
Telephone Number	:	718-937-5400
Fax Number	:	718-937-5772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELLA DEKHTYA DEKHTYAR
Credential	:	DDS
Telephone Number	:	718-937-5400

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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