Provider Demographics
NPI:1205064813
Name:41 PARK DENTAL P.C.
Entity type:Organization
Organization Name:41 PARK DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-679-7779
Mailing Address - Street 1:41 PARK AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3483
Mailing Address - Country:US
Mailing Address - Phone:212-679-7779
Mailing Address - Fax:212-679-8872
Practice Address - Street 1:41 PARK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3483
Practice Address - Country:US
Practice Address - Phone:212-679-7779
Practice Address - Fax:212-679-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty