Provider Demographics
NPI:1639372782
Name:SIROTA, CRAIG A (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:SIROTA
Suffix:
Gender:M
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5602
Mailing Address - Country:US
Mailing Address - Phone:212-758-9690
Mailing Address - Fax:212-838-1137
Practice Address - Street 1:501 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5602
Practice Address - Country:US
Practice Address - Phone:212-758-9690
Practice Address - Fax:212-838-1137
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480761223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice