Provider Demographics
NPI:1316285711
Name:COMMUNITY DENTAL CARE OF NYC PLLC
Entity type:Organization
Organization Name:COMMUNITY DENTAL CARE OF NYC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SAROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-293-1603
Mailing Address - Street 1:47 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8206
Mailing Address - Country:US
Mailing Address - Phone:718-293-1603
Mailing Address - Fax:718-293-1602
Practice Address - Street 1:47 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8206
Practice Address - Country:US
Practice Address - Phone:718-293-1603
Practice Address - Fax:718-293-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055136261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01380441Medicaid
NY03406939Medicaid