Provider Demographics
NPI:1629285853
Name:E MENA DDS,PC
Entity Type:Organization
Organization Name:E MENA DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-694-2277
Mailing Address - Street 1:600 W 150TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-2465
Mailing Address - Country:US
Mailing Address - Phone:212-694-2277
Mailing Address - Fax:212-694-3789
Practice Address - Street 1:600 W 150TH ST APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2465
Practice Address - Country:US
Practice Address - Phone:212-694-2277
Practice Address - Fax:212-694-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01708901Medicaid
NY02366076Medicaid
NY01182154Medicaid
NY01632008Medicaid