MEDICARE: DR. MARC W MICHALOWICZ D.D.S., M.SC.

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	037936	NY

General Provider Information

NPI Number	:	1841297058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC W MICHALOWICZ D.D.S., M.SC.

Provider Business Mailing Address
First Line	:	630 W 168TH ST # 20
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3725
Country	:	US
Telephone Number	:	212-305-4419
Fax Number	:

Provider Business Practice Location Address
First Line	:	COLUMBIA UNIVERSITY, COLLEGE OF DENTAL MEDICINE
Second Line	:	630 W 168TH ST SUITE VC7-226
City	:	NEW YORK
State	:	NY
Zip	:	10032-1003
Country	:	US
Telephone Number	:	212-342-0424
Fax Number	:	845-786-4938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	01/18/2023

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