Provider Demographics
NPI:1750489563
Name:42ND STREET DENTAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:42ND STREET DENTAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:NADOLNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-867-8862
Mailing Address - Street 1:120 E 42ND ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5678
Mailing Address - Country:US
Mailing Address - Phone:212-867-8862
Mailing Address - Fax:212-867-8402
Practice Address - Street 1:120 E 42ND ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5678
Practice Address - Country:US
Practice Address - Phone:212-867-8862
Practice Address - Fax:212-867-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050453122300000X
NY047883-1122300000X
NY052345-1122300000X
NY051796-1122300000X
NY0486861223E0200X
NY0443271223P0300X
NY0406901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty