Provider Demographics
NPI:1780332973
Name:ONE ENDO SUPPORT SERVICES
Entity type:Organization
Organization Name:ONE ENDO SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-777-9465
Mailing Address - Street 1:515 HALSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2715
Mailing Address - Country:US
Mailing Address - Phone:914-777-9465
Mailing Address - Fax:
Practice Address - Street 1:515 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2715
Practice Address - Country:US
Practice Address - Phone:914-777-9465
Practice Address - Fax:914-777-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12538OtherENDODONTICS
1326131236OtherENDODONTICS
NY059156OtherENDODONTICS
NY060253OtherENDODONTICS
NY049672OtherENDODONTICS
NY059403OtherENDODONTICS
CT12542OtherENDODONTICS
1023471372OtherENDODONTICS
1114459328OtherENDODONTICS