MEDICARE: DR. NATHAN THOMAS DECKER D.M.D.

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	054572-1	NY

General Provider Information

NPI Number	:	1346573953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN THOMAS DECKER D.M.D.

Provider Business Mailing Address
First Line	:	200 WATER ST APT 504
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-3558
Country	:	US
Telephone Number	:	603-396-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WATER ST APT 504
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-3558
Country	:	US
Telephone Number	:	603-396-2720
Fax Number	:

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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