Provider Demographics
NPI:1891099081
Name:ROBERT J. LOPATKIN DDS PC
Entity Type:Organization
Organization Name:ROBERT J. LOPATKIN DDS PC
Other - Org Name:ASTORIA FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-278-0358
Mailing Address - Street 1:2312 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2842
Mailing Address - Country:US
Mailing Address - Phone:718-278-0358
Mailing Address - Fax:718-278-2908
Practice Address - Street 1:2312 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2842
Practice Address - Country:US
Practice Address - Phone:718-278-0358
Practice Address - Fax:718-278-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-02
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39158-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01069685Medicaid