Provider Demographics
NPI:1851415327
Name:GARELICK, ROBERT B (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:GARELICK
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N. WELLWOOD AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-226-1155
Mailing Address - Fax:631-226-0104
Practice Address - Street 1:152 N. WELLWOOD AVE.,
Practice Address - Street 2:SUITE 6
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-226-1155
Practice Address - Fax:631-226-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351491223G0001X
NY35149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113040724Medicare UPIN