Provider Demographics
NPI:1851506505
Name:BARTLEY R. LABINER,DDS
Entity Type:Organization
Organization Name:BARTLEY R. LABINER,DDS
Other - Org Name:DR.BARTLEY R. LABINER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LABINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-583-6347
Mailing Address - Street 1:1940 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5221
Mailing Address - Country:US
Mailing Address - Phone:718-583-6347
Mailing Address - Fax:718-583-8047
Practice Address - Street 1:1940 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5221
Practice Address - Country:US
Practice Address - Phone:718-583-6347
Practice Address - Fax:718-583-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859012Medicaid