Provider Demographics
NPI:1598822496
Name:TAUB, HARLAN (DDS)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:
Last Name:TAUB
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 1:347 ROUTE 25A
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-7911
Mailing Address - Country:US
Mailing Address - Phone:631-744-3088
Mailing Address - Fax:631-744-3099
Practice Address - Street 1:347 ROUTE 25A
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-7911
Practice Address - Country:US
Practice Address - Phone:631-744-3088
Practice Address - Fax:631-744-3099
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00455252Medicaid