Provider Demographics
NPI:1568633725
Name:GREATER NEW YORK DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:GREATER NEW YORK DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUZHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-375-2870
Mailing Address - Street 1:420 PALISADE AVE
Mailing Address - Street 2:1J
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2651
Mailing Address - Country:US
Mailing Address - Phone:914-375-2870
Mailing Address - Fax:
Practice Address - Street 1:420 PALISADE AVE
Practice Address - Street 2:1J
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2651
Practice Address - Country:US
Practice Address - Phone:914-375-2870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045668261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01526067Medicaid
NY01526003Medicaid