Provider Demographics
NPI:1427183516
Name:EMPIRE STATE DENTAL GROUP PC
Entity Type:Organization
Organization Name:EMPIRE STATE DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARJOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-594-8060
Mailing Address - Street 1:350 FIFTH AVENUE
Mailing Address - Street 2:SUITE 5222
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10118
Mailing Address - Country:US
Mailing Address - Phone:212-594-8060
Mailing Address - Fax:212-594-8936
Practice Address - Street 1:350 FIFTH AVENUE
Practice Address - Street 2:SUITE 5222
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:212-594-8060
Practice Address - Fax:212-594-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty