Provider Demographics
NPI:1922439413
Name:DENTAL SERENITY OF MANHATTAN PC
Entity Type:Organization
Organization Name:DENTAL SERENITY OF MANHATTAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:LISIN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-858-9266
Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:RM 1225
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:212-858-9266
Mailing Address - Fax:212-913-9701
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:RM 1225
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-858-9266
Practice Address - Fax:212-913-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0563671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty