Provider Demographics
NPI:1356417000
Name:ORTHODONTIC ASSOCIATES OF HASBROUCK HEIGHTS PC
Entity type:Organization
Organization Name:ORTHODONTIC ASSOCIATES OF HASBROUCK HEIGHTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GORKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-288-2368
Mailing Address - Street 1:150 TERRACE AVENUE
Mailing Address - Street 2:APT 1A
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604
Mailing Address - Country:US
Mailing Address - Phone:201-288-2368
Mailing Address - Fax:201-288-2384
Practice Address - Street 1:150 TERRACE AVENUE
Practice Address - Street 2:APT 1A
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604
Practice Address - Country:US
Practice Address - Phone:201-288-2368
Practice Address - Fax:201-288-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty