Provider Demographics
NPI:1982739314
Name:BARRY L. BEHRENSDDS FRED GOODSTEINDDSPC
Entity type:Organization
Organization Name:BARRY L. BEHRENSDDS FRED GOODSTEINDDSPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-295-3090
Mailing Address - Street 1:1575 BROADWAY
Mailing Address - Street 2:STE. 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1428
Mailing Address - Country:US
Mailing Address - Phone:516-295-3090
Mailing Address - Fax:516-374-7172
Practice Address - Street 1:1575 BROADWAY
Practice Address - Street 2:STE. 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1428
Practice Address - Country:US
Practice Address - Phone:516-295-3090
Practice Address - Fax:516-374-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty