| Gregg Fader Dmd, Pc | |
|
504 Grand St Suite M5 New York NY 10002-4182 | |
| (212) 475-0051 | |
| (212) 475-3279 |
| Full Name | Gregg Fader Dmd, Pc |
|---|---|
| Speciality | Dentist |
| Location | 504 Grand St, New York, New York |
| Authorized Official Name and Position | Gregg Fader (OWNER) |
| Authorized Official Contact | 2124750051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregg Fader Dmd, Pc 504 Grand St Suite M5 New York NY 10002-4182 Ph: (212) 475-0051 | Gregg Fader Dmd, Pc 504 Grand St Suite M5 New York NY 10002-4182 Ph: (212) 475-0051 |
| NPI Number | 1831518786 |
|---|---|
| Provider Enumeration Date | 04/08/2014 |
| Last Update Date | 04/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831518786 | NPI | - | NPPES |
| 01259301 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 040972 (New York) | Primary |
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