Provider Demographics
NPI:1942584792
Name:SURESH KOSHY DDS PC
Entity Type:Organization
Organization Name:SURESH KOSHY DDS PC
Other - Org Name:EDEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:O
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-969-0168
Mailing Address - Street 1:1034 NORTH BROAD WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-969-0168
Mailing Address - Fax:914-969-6237
Practice Address - Street 1:1034 NORTH BROAD WAY
Practice Address - Street 2:EDEN DENTAL
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-969-0168
Practice Address - Fax:914-969-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty