Provider Demographics
NPI:1346661154
Name:TRIBECA BROADWAY DENTAL CARE
Entity Type:Organization
Organization Name:TRIBECA BROADWAY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:JONH
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-619-0971
Mailing Address - Street 1:291 BROADWAY
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1814
Mailing Address - Country:US
Mailing Address - Phone:212-619-0971
Mailing Address - Fax:
Practice Address - Street 1:291 BROADWAY
Practice Address - Street 2:SUITE 1105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1814
Practice Address - Country:US
Practice Address - Phone:212-619-0971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050825305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service