| Madison Avenue Periodontics, P.c. | |
|
501 Madison Ave 22nd Floor Ny NY 10022 | |
| (212) 755-1144 | |
| (212) 371-9629 |
| Full Name | Madison Avenue Periodontics, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 501 Madison Ave, Ny, New York |
| Authorized Official Name and Position | Jenny Garcia-rocha (SR CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Avenue Periodontics, P.c. 501 Madison Ave 22nd Floor Ny NY 10022 Ph: (212) 755-1144 | Madison Avenue Periodontics, P.c. 501 Madison Ave 22nd Floor Ny NY 10022 Ph: (212) 755-1144 |
| NPI Number | 1275606865 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 09/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275606865 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 35077 (New York) | Secondary |
| 122300000X | Dentist | 041733 (New York) | Secondary |
| 122300000X | Dentist | 047299 (New York) | Primary |
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