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Contact Information

STATEN ISLAND MALL DENTAL, P.C.
2655 RICHMOND AVENUE
2220
STATEN ISLAND, NY10314
 Phone: 718-982-5500
 Fax: 718-982-5554
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for STATEN ISLAND MALL DENTAL, P.C.

NPI Number 1013139237
LBN Legal business name STATEN ISLAND MALL DENTAL, P.C.
Authorized official ROSS KRASNOV - (DENTIST)
Entity Organization
Organization subpart 1 Not specified
Enumeration date 05/03/2007
Last updated 07/08/2007 - About 12 years ago
Identifiers
NY License # 046-043
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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