Provider Demographics
NPI:1841550258
Name:MIDWOOD ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:MIDWOOD ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSHADSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:718-336-6112
Mailing Address - Street 1:977 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3666
Mailing Address - Country:US
Mailing Address - Phone:718-336-6112
Mailing Address - Fax:347-462-9337
Practice Address - Street 1:977 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3666
Practice Address - Country:US
Practice Address - Phone:718-336-6112
Practice Address - Fax:347-462-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0286531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty