MEDICARE: WEST 57TH STREET 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	045131	NY

General Provider Information

NPI Number	:	1881745800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST 57TH STREET DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	119 W 57TH ST STE 1420
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2401
Country	:	US
Telephone Number	:	212-757-5749
Fax Number	:	212-307-7309

Provider Business Practice Location Address
First Line	:	119 W 57TH ST STE 1420
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2401
Country	:	US
Telephone Number	:	212-757-5749
Fax Number	:	212-307-7309

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	JOANNA MURPHY
Credential	:
Telephone Number	:	212-757-5749

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/10/2007

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