Provider Demographics
NPI:1972031441
Name:SHAY MARKOVITCH DENTISTRY PLLC
Entity Type:Organization
Organization Name:SHAY MARKOVITCH DENTISTRY PLLC
Other - Org Name:WAPPINGERS FALLS DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-297-0757
Mailing Address - Street 1:1323 ROUTE 9 STE 209
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4977
Mailing Address - Country:US
Mailing Address - Phone:845-297-0757
Mailing Address - Fax:845-297-0106
Practice Address - Street 1:1323 ROUTE 9 STE 209
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4977
Practice Address - Country:US
Practice Address - Phone:845-297-0757
Practice Address - Fax:845-297-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054658122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03519528Medicaid
NY7876830001OtherMEDICARE