| NPI | 1538621305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA KOROBEYNYK Rcm 516-654-4400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0300X Dentist, Periodontics | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2023-02-21 |