Provider Demographics
NPI:1366818627
Name:ASTORIA DENTAL DESIGN
Entity Type:Organization
Organization Name:ASTORIA DENTAL DESIGN
Other - Org Name:MIDTOWN DENTAL DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVRATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-572-9800
Mailing Address - Street 1:45 W 54TH ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5404
Mailing Address - Country:US
Mailing Address - Phone:212-572-9800
Mailing Address - Fax:347-436-9569
Practice Address - Street 1:45 W 54TH ST
Practice Address - Street 2:STE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5404
Practice Address - Country:US
Practice Address - Phone:212-572-9800
Practice Address - Fax:347-436-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty