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NPI Code Detail

MEDICARE: CANARSIE FAMILY & COSMETIC DENTISTRY PC

MEDICARE: CANARSIE FAMILY & COSMETIC DENTISTRY 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
1261QD0000XDental Clinic/Center043555NY

General Provider Information

NPI Number : 1447650643
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANARSIE FAMILY & COSMETIC DENTISTRY PC
Provider Business Mailing Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-531-9100
Fax Number : 718-968-9469
Provider Business Practice Location Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-531-9100
Fax Number : 718-968-9469
Authorized Official
Title or Position : PRESIDENT
Name : DR. LAWRENCE J WEISS
Credential : D.D.S
Telephone Number : 516-849-3062
Provider Enumeration Date : 08/26/2014
Last Update Date : 08/26/2014

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