Provider Demographics
NPI:1588949804
Name:ASTORIA DENTAL STUDIO, P.C.
Entity type:Organization
Organization Name:ASTORIA DENTAL STUDIO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPOZHNIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-545-7046
Mailing Address - Street 1:3018 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2405
Mailing Address - Country:US
Mailing Address - Phone:718-545-7046
Mailing Address - Fax:
Practice Address - Street 1:3018 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2405
Practice Address - Country:US
Practice Address - Phone:718-545-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03238213Medicaid