Provider Demographics
NPI:1255777348
Name:BIDERMAN DENTAL PC
Entity type:Organization
Organization Name:BIDERMAN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-843-9209
Mailing Address - Street 1:9019 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2739
Mailing Address - Country:US
Mailing Address - Phone:718-843-9209
Mailing Address - Fax:718-843-4140
Practice Address - Street 1:90-19 157 AVE.
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-843-9209
Practice Address - Fax:718-843-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty