| Elite Dental Of Staten Island,pc | |
|
2291 Victory Blvd Staten Island NY 10314-6625 | |
| (718) 370-1200 | |
| (718) 370-1207 |
| Full Name | Elite Dental Of Staten Island,pc |
|---|---|
| Speciality | Dentist |
| Location | 2291 Victory Blvd, Staten Island, New York |
| Authorized Official Name and Position | Steven R Acker (OWNER) |
| Authorized Official Contact | 7183701200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Dental Of Staten Island,pc 2291 Victory Blvd Staten Island NY 10314-6625 Ph: (718) 370-1200 | Elite Dental Of Staten Island,pc 2291 Victory Blvd Staten Island NY 10314-6625 Ph: (718) 370-1200 |
| NPI Number | 1043632318 |
|---|---|
| Provider Enumeration Date | 01/06/2014 |
| Last Update Date | 05/20/2014 |
| Medicare PECOS PAC ID | 6901038421 |
|---|---|
| Medicare Enrollment ID | O20140416001676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043632318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 036474 (New York) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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