Provider Demographics
NPI:1588022297
Name:JYOTI SRIVASTAVA DDS & ROBERT CASTRACANE DMD LLC
Entity Type:Organization
Organization Name:JYOTI SRIVASTAVA DDS & ROBERT CASTRACANE DMD LLC
Other - Org Name:EASTSIDE DENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,DDS
Authorized Official - Phone:212-758-9498
Mailing Address - Street 1:595 MADISON AVE FL 27
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1649
Mailing Address - Country:US
Mailing Address - Phone:212-758-9498
Mailing Address - Fax:
Practice Address - Street 1:595 MADISON AVE FL 27
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1649
Practice Address - Country:US
Practice Address - Phone:212-758-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty