Provider Demographics
NPI:1205047693
Name:MT. SINAI FAMILY DENTAL
Entity type:Organization
Organization Name:MT. SINAI FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-331-8989
Mailing Address - Street 1:5505 NESCONSET HWY
Mailing Address - Street 2:STE. 230
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2037
Mailing Address - Country:US
Mailing Address - Phone:631-331-8989
Mailing Address - Fax:631-331-7962
Practice Address - Street 1:5505 NESCONSET HWY
Practice Address - Street 2:STE. 230
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2037
Practice Address - Country:US
Practice Address - Phone:631-331-8989
Practice Address - Fax:631-331-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471181223E0200X
NY0470781223G0001X
NY0483421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty