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65 Broadway Ste 408 New York NY 10006-2546 | |
| (212) 430-3888 | |
| (212) 430-3889 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 65 Broadway Ste 408, New York, New York |
| Authorized Official Name and Position | Alexander Heifitz (PRESIDENT) |
| Authorized Official Contact | 2124303888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
65 Broadway Suite 408 New York NY 10006-2546 Ph: (212) 430-3888 | 65 Broadway Ste 408 New York NY 10006-2546 Ph: (212) 430-3888 |
| NPI Number | 1831203199 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 11/11/2024 |
| Medicare PECOS PAC ID | 9739628785 |
|---|---|
| Medicare Enrollment ID | O20240822001795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831203199 | NPI | - | NPPES |
| 0471301 | Other | LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0471301 (New York) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Alexander Heifitz |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1952405235 PECOS PAC ID: 1355880303 Enrollment ID: I20240822002192 |
| Provider Name | Haemin Chin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1720349400 PECOS PAC ID: 4486189024 Enrollment ID: I20241120000333 |
| Provider Name | Jaemin Chin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417784448 PECOS PAC ID: 3779019187 Enrollment ID: I20241209003376 |
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