| 2791 Richmond Llc | |
|
2791 Richmond Avenue, Suite 2 Staten Island NY 10314 | |
| (718) 400-9002 | |
| Not Available |
| Full Name | 2791 Richmond Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2791 Richmond Avenue, Suite 2, Staten Island, New York |
| Authorized Official Name and Position | Toni Lynn Egan (CREDENTIALING DEPARTMENT) |
| Authorized Official Contact | 7189792121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 2791 Richmond Llc 2791 Richmond Ave Ste 2 Staten Island NY 10314-5859 Ph: (718) 400-9002 | 2791 Richmond Llc 2791 Richmond Avenue, Suite 2 Staten Island NY 10314 Ph: (718) 400-9002 |
| NPI Number | 1003391186 |
|---|---|
| Provider Enumeration Date | 09/25/2018 |
| Last Update Date | 09/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003391186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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