Provider Demographics
NPI:1649417676
Name:JONATHAN ROBERTS DDS & CRAIG SIROTA DMD PC
Entity type:Organization
Organization Name:JONATHAN ROBERTS DDS & CRAIG SIROTA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:SIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-758-9690
Mailing Address - Street 1:501 MADISON AVENUE
Mailing Address - Street 2:24TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-758-9690
Mailing Address - Fax:212-838-1137
Practice Address - Street 1:501 MADISON AVENUE
Practice Address - Street 2:24TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-758-9690
Practice Address - Fax:212-838-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0346321223P0700X
NY0229371223P0700X
NY048076-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty