| NPI | 1053857532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GITLIN Owner 516-579-8950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 041069) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057365) |
| 122300000X Dentist (Licence: NY 049803) | |
| 122300000X Dentist (Licence: NY 057457) | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |