MEDICARE: ISLAND DENTAL ASSOCIATES

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	043935	NY

General Provider Information

NPI Number	:	1750557609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	639 HEMPSTEAD TPKE
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-4334
Country	:	US
Telephone Number	:	516-565-6565
Fax Number	:	516-565-3391

Provider Business Practice Location Address
First Line	:	639 HEMPSTEAD TPKE
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-4334
Country	:	US
Telephone Number	:	516-565-6565
Fax Number	:	516-565-3391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC WEINSTEIN
Credential	:	DDS
Telephone Number	:	516-565-6565

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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Directions to “ISLAND DENTAL ASSOCIATES ” Practice Location

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