| Dental Specialty Associates Pc | |
|
225 Broadway Suite #105 New York NY 10007-3001 | |
| (212) 374-9500 | |
| (212) 732-0267 |
| Full Name | Dental Specialty Associates Pc |
|---|---|
| Speciality | Dentist |
| Location | 225 Broadway, New York, New York |
| Authorized Official Name and Position | Paul Irving Cohen (PRESIDENT) |
| Authorized Official Contact | 2123749500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Specialty Associates Pc 225 Broadway Suite #105 New York NY 10007-3001 Ph: (212) 374-9500 | Dental Specialty Associates Pc 225 Broadway Suite #105 New York NY 10007-3001 Ph: (212) 374-9500 |
| NPI Number | 1275592693 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6608184015 |
|---|---|
| Medicare Enrollment ID | O20151005002970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275592693 | NPI | - | NPPES |
| 02593511 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Kayvan Fathimani |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1396040127 PECOS PAC ID: 4789995739 Enrollment ID: I20150618000175 |
| Provider Name | Stanley E Matthews |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1144665506 PECOS PAC ID: 5395053706 Enrollment ID: I20151005003134 |
| Provider Name | Anayo O Adachie |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134356157 PECOS PAC ID: 1951600832 Enrollment ID: I20160427001147 |
| Provider Name | Yaakov Allaeb |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1104203272 PECOS PAC ID: 0345572475 Enrollment ID: I20191023000340 |
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