Provider Demographics
NPI:1225388127
Name:NEWBURGH DENTAL GROUP
Entity Type:Organization
Organization Name:NEWBURGH DENTAL GROUP
Other - Org Name:NEWBURGH DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-320-8247
Mailing Address - Street 1:31 S PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3901
Mailing Address - Country:US
Mailing Address - Phone:845-565-2140
Mailing Address - Fax:845-565-2229
Practice Address - Street 1:31 S PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3901
Practice Address - Country:US
Practice Address - Phone:845-565-2140
Practice Address - Fax:845-565-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03528787Medicaid