Provider Demographics
NPI:1730351388
Name:NEIGHBORHOOD DENATL OF ELMHURST
Entity type:Organization
Organization Name:NEIGHBORHOOD DENATL OF ELMHURST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLAPIETRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-963-9500
Mailing Address - Street 1:7911 41ST AVE
Mailing Address - Street 2:SUITE A107
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1258
Mailing Address - Country:US
Mailing Address - Phone:718-205-2888
Mailing Address - Fax:718-205-2855
Practice Address - Street 1:7911 41ST AVE
Practice Address - Street 2:SUITE A107
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1258
Practice Address - Country:US
Practice Address - Phone:718-205-2888
Practice Address - Fax:718-205-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045167-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484697Medicaid