MEDICARE: NY1DENTAL ASSOCIATED P.C.

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	047422	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497926257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY1DENTAL ASSOCIATED P.C.

Provider Business Mailing Address
First Line	:	1214 CONEY ISLAND AVE
Second Line	:	DENTAL
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2912
Country	:	US
Telephone Number	:	718-258-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 CONEY ISLAND AVE
Second Line	:	DENTAL
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2912
Country	:	US
Telephone Number	:	718-258-8222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SEVIL PINKHASOV
Credential	:	DDS
Telephone Number	:	718-258-8222

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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