NPIMap

Organization Active NPI

Fordham Road Dental PC

  • General Practice Dentistry
  • Bronx, NY
National Provider Identifier
1306050869
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FORDHAM ROAD DENTAL PC
Practice address
327 E Fordham Rd
2ND Floor
Bronx, NY 10458-5002
Phone
(718) 933-8400
Fax
(718) 933-3731
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diane Bertuzzi
Title
Practice Manager
Phone
(845) 304-6110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

327 E Fordham Rd
2ND Floor
Bronx, NY 10458-5002

Mailing address

327 E Fordham Rd
2ND Floor
Bronx, NY 10458-5002
Phone (718) 933-8400

Other names 1

  • Executive Associates, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

327 E Fordham Rd
Bronx, NY 10458
Phone (718) 733-8400

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1306050869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 E FORDHAM RD",
            "address_2": "2ND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104585002",
            "telephone_number": "718-933-8400",
            "fax_number": "718-933-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 E FORDHAM RD",
            "address_2": "2ND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104585002",
            "telephone_number": "718-933-8400",
            "fax_number": "718-933-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDHAM ROAD DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "BERTUZZI",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "845-304-6110"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Executive Associates, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.