Provider Demographics
NPI:1962877845
Name:EAST HARLEM DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:EAST HARLEM DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-817-3860
Mailing Address - Street 1:201 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5418
Mailing Address - Country:US
Mailing Address - Phone:212-348-5492
Mailing Address - Fax:212-828-0905
Practice Address - Street 1:1040 1ST AVE
Practice Address - Street 2:#393
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2991
Practice Address - Country:US
Practice Address - Phone:917-991-1841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02441936Medicaid