Provider Demographics
NPI:1952526642
Name:WOODBURY FAMILY DENTAL
Entity Type:Organization
Organization Name:WOODBURY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-782-1800
Mailing Address - Street 1:118 RIVER RD
Mailing Address - Street 2:SUITE # 14
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3021
Mailing Address - Country:US
Mailing Address - Phone:845-782-1800
Mailing Address - Fax:845-782-3116
Practice Address - Street 1:118 RIVER ROAD
Practice Address - Street 2:SUITE # 14
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3021
Practice Address - Country:US
Practice Address - Phone:845-782-1800
Practice Address - Fax:845-782-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207743Medicaid