Provider Demographics
NPI:1386811933
Name:MICHAEL K EMANUEL DDS SHIRLEY LEW DMD PC
Entity type:Organization
Organization Name:MICHAEL K EMANUEL DDS SHIRLEY LEW DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT OF PROFESSIO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-336-5005
Mailing Address - Street 1:2053 EAST 16 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-336-5005
Mailing Address - Fax:718-336-8679
Practice Address - Street 1:2053 EAST 16 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-336-5005
Practice Address - Fax:718-336-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01779620Medicaid