Provider Demographics
NPI:1467047340
Name:WOODHAVEN JAMAICA ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:WOODHAVEN JAMAICA ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITKOUVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-391-8000
Mailing Address - Street 1:2954 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1343
Mailing Address - Country:US
Mailing Address - Phone:917-391-8000
Mailing Address - Fax:
Practice Address - Street 1:2954 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1343
Practice Address - Country:US
Practice Address - Phone:917-391-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty