Provider Demographics
NPI:1477780823
Name:BEN ZVI, JUSTIN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:BEN ZVI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MAMARONECK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1900
Mailing Address - Country:US
Mailing Address - Phone:914-835-6004
Mailing Address - Fax:
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:STE 2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5524
Practice Address - Country:US
Practice Address - Phone:718-901-8110
Practice Address - Fax:718-901-8121
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055257-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370821Medicaid