Provider Demographics
NPI:1134218498
Name:DELANCEY DENTAL, P.C.
Entity type:Organization
Organization Name:DELANCEY DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCARENHAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-695-5057
Mailing Address - Street 1:1350 BROADWAY
Mailing Address - Street 2:SUITE 2104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7702
Mailing Address - Country:US
Mailing Address - Phone:212-695-5057
Mailing Address - Fax:212-242-3241
Practice Address - Street 1:288 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3015
Practice Address - Country:US
Practice Address - Phone:845-838-0086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04896811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02713422Medicaid
NY02634917Medicaid
NY02099310Medicaid
NYA1807OtherHEALTHPLEXINC. PROVIDER #
NY0016750OtherDORAL USA PROVIDER NUMBER
NY02691725Medicaid