Provider Demographics
NPI:1306390182
Name:DELLANIRA ROSARIO-LEGER DENTISTRY
Entity type:Organization
Organization Name:DELLANIRA ROSARIO-LEGER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:DELLANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO-LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-740-1208
Mailing Address - Street 1:701 W 179TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6027
Mailing Address - Country:US
Mailing Address - Phone:212-740-1208
Mailing Address - Fax:212-740-7755
Practice Address - Street 1:701 W 179TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6027
Practice Address - Country:US
Practice Address - Phone:212-740-1208
Practice Address - Fax:212-740-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01137377Medicaid