Provider Demographics
NPI:1851494009
Name:GREENWALD & MATANI PTR
Entity Type:Organization
Organization Name:GREENWALD & MATANI PTR
Other - Org Name:DENTAL ASSOCIATES OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-691-2112
Mailing Address - Street 1:241 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2320
Mailing Address - Country:US
Mailing Address - Phone:212-691-2112
Mailing Address - Fax:212-691-2115
Practice Address - Street 1:241 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2320
Practice Address - Country:US
Practice Address - Phone:212-691-2112
Practice Address - Fax:212-691-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290751223G0001X
NY309211223G0001X
NY490251223P0300X
NY493791223P0300X
NY0523121223P0300X
NY468551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12034OtherAETNA-DMO