Provider Demographics
NPI:1417013509
Name:CONVISSAR AND GOLDSTEIN DDS
Entity Type:Organization
Organization Name:CONVISSAR AND GOLDSTEIN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONVISSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-255-5730
Mailing Address - Street 1:200 PARK AVE S
Mailing Address - Street 2:SUITE 1414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1503
Mailing Address - Country:US
Mailing Address - Phone:212-255-5730
Mailing Address - Fax:212-533-8232
Practice Address - Street 1:200 PARK AVE S
Practice Address - Street 2:SUITE 1414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1503
Practice Address - Country:US
Practice Address - Phone:212-255-5730
Practice Address - Fax:212-533-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty