| 99-04 57th Avenue, Inc. | |
|
9904 57th Ave Suite Lh Corona NY 11368-3746 | |
| (718) 760-0471 | |
| (718) 760-4739 |
| Full Name | 99-04 57th Avenue, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 9904 57th Ave, Corona, New York |
| Authorized Official Name and Position | Maria E Acebo (OWNER) |
| Authorized Official Contact | 7187600471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 99-04 57th Avenue, Inc. 9904 57th Ave Suite Lh Corona NY 11368-3746 Ph: (718) 760-0471 | 99-04 57th Avenue, Inc. 9904 57th Ave Suite Lh Corona NY 11368-3746 Ph: (718) 760-0471 |
| NPI Number | 1679977680 |
|---|---|
| Provider Enumeration Date | 10/20/2014 |
| Last Update Date | 10/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679977680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0438701 (New York) | Primary |
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