MEDICARE: ST MARKS PLACE 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
1	261QD0000X	Dental Clinic/Center	028630	NY

General Provider Information

NPI Number	:	1518140789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARKS PLACE DENTISTRY PC

Provider Business Mailing Address
First Line	:	70 SAINT MARKS PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-8150
Country	:	US
Telephone Number	:	212-475-8692
Fax Number	:	212-475-0881

Provider Business Practice Location Address
First Line	:	1244 DUTCH BROADWAY
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1513
Country	:	US
Telephone Number	:	212-475-8692
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. I MICHAEL POSTOL
Credential	:	DDS
Telephone Number	:	212-475-8692

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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