Provider Demographics
NPI:1437379799
Name:LAWRENCE M ITSKOWITCH DDS,PC
Entity Type:Organization
Organization Name:LAWRENCE M ITSKOWITCH DDS,PC
Other - Org Name:ROOSEVELY ISLAND FAMILY AND COSMETIC DENTIS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ITSKOWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-752-8722
Mailing Address - Street 1:501A MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044
Mailing Address - Country:US
Mailing Address - Phone:212-752-8722
Mailing Address - Fax:212-759-5507
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:A
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044
Practice Address - Country:US
Practice Address - Phone:212-752-8722
Practice Address - Fax:212-759-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27566261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental