Provider Demographics
NPI:1639282718
Name:PARK 56 DENTAL GROUP P.C.
Entity Type:Organization
Organization Name:PARK 56 DENTAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VITULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-826-2322
Mailing Address - Street 1:120 E 56TH ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:212-826-2322
Mailing Address - Fax:212-935-3892
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-826-2322
Practice Address - Fax:212-935-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty