Provider Demographics
NPI:1891889218
Name:ARTENBERG, PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ARTENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 86TH ST
Mailing Address - Street 2:11M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3000
Mailing Address - Country:US
Mailing Address - Phone:646-389-8772
Mailing Address - Fax:
Practice Address - Street 1:240 E 86TH ST
Practice Address - Street 2:11M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3000
Practice Address - Country:US
Practice Address - Phone:646-389-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040883-011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01488962Medicaid