Provider Demographics
NPI:1538422365
Name:THE INTEGRATIVE DENTAL PRACTICE OF NY, PLLC
Entity type:Organization
Organization Name:THE INTEGRATIVE DENTAL PRACTICE OF NY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:
Authorized Official - Last Name:WINICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-973-9425
Mailing Address - Street 1:120 E 56TH ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:212-973-9425
Mailing Address - Fax:212-973-1029
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-973-9425
Practice Address - Fax:212-973-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment