Provider Demographics
NPI:1417317124
Name:PRESTIGE FIFTH AVENUE DENTAL P C
Entity Type:Organization
Organization Name:PRESTIGE FIFTH AVENUE DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMKHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-682-5060
Mailing Address - Street 1:110 E 40TH ST RM 406
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1801
Mailing Address - Country:US
Mailing Address - Phone:212-682-5060
Mailing Address - Fax:212-683-4330
Practice Address - Street 1:110 E 40TH ST RM 406
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-682-5060
Practice Address - Fax:212-683-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty