Provider Demographics
NPI:1235646753
Name:EMAGEN DENTAL LLC
Entity Type:Organization
Organization Name:EMAGEN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-352-9300
Mailing Address - Street 1:603 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3696
Mailing Address - Country:US
Mailing Address - Phone:212-352-9300
Mailing Address - Fax:212-352-9303
Practice Address - Street 1:603 GREENWICH ST STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-7073
Practice Address - Country:US
Practice Address - Phone:212-352-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053902122300000X
NY0539311223P0300X
NY0539761223P0300X
NY0480551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty