Provider Demographics
NPI:1558677864
Name:STEINWAY 26 DENTISTRY PC
Entity Type:Organization
Organization Name:STEINWAY 26 DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-847-5555
Mailing Address - Street 1:3027 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3801
Mailing Address - Country:US
Mailing Address - Phone:718-777-8000
Mailing Address - Fax:718-204-2020
Practice Address - Street 1:3027 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3801
Practice Address - Country:US
Practice Address - Phone:718-777-8000
Practice Address - Fax:718-204-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03060184Medicaid