Provider Demographics
NPI:1831567528
Name:MARSHALL S SKOPP DMD PC
Entity type:Organization
Organization Name:MARSHALL S SKOPP DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-982-5230
Mailing Address - Street 1:2040 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1755
Mailing Address - Country:US
Mailing Address - Phone:718-982-5230
Mailing Address - Fax:718-982-5231
Practice Address - Street 1:2040 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1755
Practice Address - Country:US
Practice Address - Phone:718-982-5230
Practice Address - Fax:718-982-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO45275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty