NYU College of Dentistry
Organization Active NPI Dental Clinic/Center · New York, NY
NPI 1780804344 · NPPES record last updated Apr 16, 2019
Key facts
- NPI
- 1780804344
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- 021314-2 (NY)
- Legal business name
- NYU COLLEGE OF DENTISTRY
- Practice address
- 726 Broadway
Suite 350
New York, NY 10003-9502 - Phone
- (212) 443-1300
- Fax
- (212) 443-1331
- NPI assigned
- Apr 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert S Glickman, DDS
- Title
- Assoc Dean Clinical Affairs
- Phone
- (212) 443-1322
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121002000667 | NY | Part B Supplier - Clinic/Group Practice | 1355232422 |
Receives reassigned benefits from 16 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New York, NY |
National Provider Directory
- Tax ID family
- NYU Anesthesia Assoc
Locations
726 Broadway
Ste 350
New York, NY 10003
Phone (212) 443-1300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Dental Clinic/Center | 261QD0000X | 021314-2 | NY | Yes |
Addresses
Primary practice location
726 Broadway
Suite 350
New York, NY 10003-9502
Mailing address
726 Broadway
Suite 350
New York, NY 10003-9502
Phone (212) 443-1300
Other names
- FACULTY PRACTICE SOUTH
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- NYU Dental Faculty Practice
All providers in New York, NY · Dental Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.