MEDICARE: WASHINGTON HEIGHTS ORTHODONTICS PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1831638840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON HEIGHTS ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	200 E 15TH ST
Second Line	:	SUITE PRB
City	:	NEW YORK
State	:	NY
Zip	:	10003-3902
Country	:	US
Telephone Number	:	212-777-9177
Fax Number	:	212-777-9178

Provider Business Practice Location Address
First Line	:	200 E 15TH ST
Second Line	:	SUITE PRB
City	:	NEW YORK
State	:	NY
Zip	:	10003-3902
Country	:	US
Telephone Number	:	212-777-9177
Fax Number	:	212-777-9178

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON BERK
Credential	:	DDS
Telephone Number	:	212-777-9177

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	03/09/2017

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