| Professional Corporation | |
|
3305 Jerusalem Avenue Suite 102 Wantagh NY 11793 | |
| (516) 679-5959 | |
| Not Available |
| Full Name | Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 3305 Jerusalem Avenue, Wantagh, New York |
| Authorized Official Name and Position | Lawrence Robert Rosenzweig (PRESIDENT) |
| Authorized Official Contact | 5166795959 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Corporation 3305 Jerusalem Avenue Suite 102 Wantagh NY 11793 Ph: (516) 679-5959 | Professional Corporation 3305 Jerusalem Avenue Suite 102 Wantagh NY 11793 Ph: (516) 679-5959 |
| NPI Number | 1013094523 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013094523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 037844 (New York) | Primary |
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