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Contact Information

4TH AVENUE DENTAL PC
157 S 4TH AVE
MOUNT VERNON, NY10550-3106
 Phone: 914-664-5342
 Fax: 718-275-3049
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for 4TH AVENUE DENTAL PC

NPI Number 1356580914
LBN Legal business name 4TH AVENUE DENTAL PC
Authorized official HARESH SHAH - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/05/2009
Last updated 02/05/2009 - About 17 years ago
Identifiers
NY License # 036630
NY Medicaid 00729819
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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