Provider Demographics
NPI:1770862930
Name:BIG APPLE DENTAL PC
Entity Type:Organization
Organization Name:BIG APPLE DENTAL PC
Other - Org Name:BIG APPLE DENTAL PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SVERDLOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-927-1117
Mailing Address - Street 1:348 FORT WASHINGTON AVE
Mailing Address - Street 2:AVENUE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6834
Mailing Address - Country:US
Mailing Address - Phone:212-927-1117
Mailing Address - Fax:
Practice Address - Street 1:348 FORT WASHINGTON AVE
Practice Address - Street 2:AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6834
Practice Address - Country:US
Practice Address - Phone:212-927-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047567-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081823312Medicaid