| NPI | 1205229044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY HERSKOVITS Dentist 718-745-3456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 36187) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 46724) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 36187) | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-30 |