Provider Demographics
NPI:1952443442
Name:ASTORIA MODERN FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:ASTORIA MODERN FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-721-4700
Mailing Address - Street 1:3156 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3909
Mailing Address - Country:US
Mailing Address - Phone:718-721-4700
Mailing Address - Fax:718-204-5641
Practice Address - Street 1:3156 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3909
Practice Address - Country:US
Practice Address - Phone:718-721-4700
Practice Address - Fax:718-204-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744310Medicaid