| Coney Island Dental P.c. | |
|
2882 W 15th St Uppr Level Brooklyn NY 11224-2770 | |
| (718) 336-1777 | |
| (718) 887-3959 |
| Full Name | Coney Island Dental P.c. |
|---|---|
| Speciality | Dentist |
| Location | 2882 W 15th St Uppr Level, Brooklyn, New York |
| Authorized Official Name and Position | Yevgeny Pasechnik (MANAGER) |
| Authorized Official Contact | 7187668883 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coney Island Dental P.c. 2882 W 15th St Uppr Level Brooklyn NY 11224-2770 Ph: (718) 336-1777 | Coney Island Dental P.c. 2882 W 15th St Uppr Level Brooklyn NY 11224-2770 Ph: (718) 336-1777 |
| NPI Number | 1255720322 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 04/09/2021 |
| Medicare PECOS PAC ID | 4880003250 |
|---|---|
| Medicare Enrollment ID | O20210514002128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255720322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (New York) | Primary |
| Provider Name | Serge Kupetz |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437250289 PECOS PAC ID: 6901189299 Enrollment ID: I20210517001927 |
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