Provider Demographics
NPI:1235480450
Name:NEW YORK ORTHODONTIC GROUP DBA JACKSON HEIGHTS ORTHODONTICS
Entity Type:Organization
Organization Name:NEW YORK ORTHODONTIC GROUP DBA JACKSON HEIGHTS ORTHODONTICS
Other - Org Name:JACKSON HEIGHTS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EFSTATHIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNOUTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-335-4444
Mailing Address - Street 1:7409 37TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-335-4444
Mailing Address - Fax:718-335-1855
Practice Address - Street 1:7409 37TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6300
Practice Address - Country:US
Practice Address - Phone:718-335-4444
Practice Address - Fax:718-335-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0524161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty