Provider Demographics
NPI:1831403153
Name:NEW ENGLAND ORTHODONTICS PLLC
Entity type:Organization
Organization Name:NEW ENGLAND ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZMUIDZINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-200-3797
Mailing Address - Street 1:1957 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4006
Mailing Address - Country:US
Mailing Address - Phone:585-200-3797
Mailing Address - Fax:
Practice Address - Street 1:1500 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5132
Practice Address - Country:US
Practice Address - Phone:585-200-3797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty