Provider Demographics
NPI:1972621084
Name:FAMILY HEALTH DENTAL OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH DENTAL OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-987-8999
Mailing Address - Street 1:3044 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2087
Mailing Address - Country:US
Mailing Address - Phone:718-987-8999
Mailing Address - Fax:718-351-0400
Practice Address - Street 1:3044 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2087
Practice Address - Country:US
Practice Address - Phone:718-987-8999
Practice Address - Fax:718-351-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty