Provider Demographics
NPI:1831638840
Name:WASHINGTON HEIGHTS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:WASHINGTON HEIGHTS ORTHODONTICS PLLC
Other - Org Name:GRAMERCY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-777-9177
Mailing Address - Street 1:200 E 15TH ST
Mailing Address - Street 2:SUITE PRB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3902
Mailing Address - Country:US
Mailing Address - Phone:212-777-9177
Mailing Address - Fax:212-777-9178
Practice Address - Street 1:200 E 15TH ST
Practice Address - Street 2:SUITE PRB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3902
Practice Address - Country:US
Practice Address - Phone:212-777-9177
Practice Address - Fax:212-777-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty