Provider Demographics
NPI:1093800815
Name:GARY H COELHO,DDS, DOMINIC A GALASSO, DDS AND JEROLD A FELDMAN,DDS,PC
Entity Type:Organization
Organization Name:GARY H COELHO,DDS, DOMINIC A GALASSO, DDS AND JEROLD A FELDMAN,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-686-3953
Mailing Address - Street 1:12 E 41ST ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6221
Mailing Address - Country:US
Mailing Address - Phone:212-686-3953
Mailing Address - Fax:212-889-5558
Practice Address - Street 1:12 E 41ST ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6221
Practice Address - Country:US
Practice Address - Phone:212-686-3953
Practice Address - Fax:212-889-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26865OtherLICENSE #
NY33674OtherLICENSE #
NY33676OtherLICENSE #