MEDICARE: DR. ADINA CARREL DMD

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	045973	NY

General Provider Information

NPI Number	:	1386715506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADINA CARREL DMD

Provider Business Mailing Address
First Line	:	630 5TH AVE
Second Line	:	SUITE 1860
City	:	NEW YORK
State	:	NY
Zip	:	10111-0100
Country	:	US
Telephone Number	:	212-765-7340
Fax Number	:	212-489-1215

Provider Business Practice Location Address
First Line	:	630 5TH AVE
Second Line	:	SUITE 1860
City	:	NEW YORK
State	:	NY
Zip	:	10111-0100
Country	:	US
Telephone Number	:	212-765-7340
Fax Number	:	212-489-1215

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	10/16/2012

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