Provider Demographics
NPI:1427295062
Name:NG DENTAL GALLERY
Entity type:Organization
Organization Name:NG DENTAL GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-828-4200
Mailing Address - Street 1:2027 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2858
Mailing Address - Country:US
Mailing Address - Phone:212-828-4200
Mailing Address - Fax:212-828-7649
Practice Address - Street 1:2027 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2858
Practice Address - Country:US
Practice Address - Phone:212-828-4200
Practice Address - Fax:212-828-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050360-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360814Medicaid