Provider Demographics
NPI:1053608653
Name:RYE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:RYE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-967-0000
Mailing Address - Street 1:130 THEODORE FREMD AVE APT M2
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-6813
Mailing Address - Country:US
Mailing Address - Phone:914-967-0000
Mailing Address - Fax:914-967-0149
Practice Address - Street 1:130 THEODORE FREMD AVE APT M2
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-6813
Practice Address - Country:US
Practice Address - Phone:914-967-0000
Practice Address - Fax:914-967-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-02
Last Update Date:2011-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515561223P0221X
NY0518461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty