Provider Demographics
NPI:1679997456
Name:NEWYORKAVE DENTAL PC
Entity type:Organization
Organization Name:NEWYORKAVE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NUZHAT
Authorized Official - Middle Name:HAROON
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-385-5650
Mailing Address - Street 1:20 OVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2737
Mailing Address - Country:US
Mailing Address - Phone:631-385-5650
Mailing Address - Fax:
Practice Address - Street 1:1395 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1705
Practice Address - Country:US
Practice Address - Phone:163-138-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty