Provider Demographics
NPI:1417026295
Name:PARK AVE PEDIATRIC DENTAL OFFICE
Entity Type:Organization
Organization Name:PARK AVE PEDIATRIC DENTAL OFFICE
Other - Org Name:DR. DEBORAH PILLA, DR. ANN LAMBERT, DR. LIRAZ SPEAR
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DOLLY
Authorized Official - Last Name:ROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-879-6518
Mailing Address - Street 1:870 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1806
Mailing Address - Country:US
Mailing Address - Phone:212-879-6518
Mailing Address - Fax:212-879-6578
Practice Address - Street 1:870 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-879-6518
Practice Address - Fax:212-879-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN