Provider Demographics
NPI:1215058201
Name:RALLIS DENTISTRY OF MANHASSET
Entity type:Organization
Organization Name:RALLIS DENTISTRY OF MANHASSET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:I
Authorized Official - Last Name:RALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-627-0362
Mailing Address - Street 1:45 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1928
Mailing Address - Country:US
Mailing Address - Phone:516-627-0362
Mailing Address - Fax:516-869-1515
Practice Address - Street 1:45 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1928
Practice Address - Country:US
Practice Address - Phone:516-627-0362
Practice Address - Fax:516-869-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416741223G0001X
1223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty