| NPI | 1649318601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDZHELA P TKACHUK Director 718-273-5006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 050679) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2010-12-22 |