Provider Demographics
NPI:1649424045
Name:4290 WASHINGTON HEIGHTS DENTAL
Entity Type:Organization
Organization Name:4290 WASHINGTON HEIGHTS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-780-0166
Mailing Address - Street 1:4290 BROADWAY # 2S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3732
Mailing Address - Country:US
Mailing Address - Phone:212-781-0166
Mailing Address - Fax:
Practice Address - Street 1:4290 BROADWAY # 2S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3732
Practice Address - Country:US
Practice Address - Phone:212-781-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049809122300000X
NY050606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty