Provider Demographics
NPI:1710179890
Name:OSTERMAN, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:OSTERMAN
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 1:595 MADISON AVE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1907
Mailing Address - Country:US
Mailing Address - Phone:212-755-9882
Mailing Address - Fax:
Practice Address - Street 1:595 MADISON AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1907
Practice Address - Country:US
Practice Address - Phone:212-755-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451521223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics