Provider Demographics
NPI:1093351124
Name:DENTAL ON THE HUDSON
Entity Type:Organization
Organization Name:DENTAL ON THE HUDSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-852-1260
Mailing Address - Street 1:2735 HENRY HUDSON PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4701
Mailing Address - Country:US
Mailing Address - Phone:718-601-2685
Mailing Address - Fax:
Practice Address - Street 1:2735 HENRY HUDSON PKWY STE 203
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4701
Practice Address - Country:US
Practice Address - Phone:718-601-2685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental