125TH Street Orthodontics, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

046957 Issued in NY

Legal business name

125TH STREET ORTHODONTICS, PC

Practice address

360 W 125TH St
Suite 8
New York, NY 10027-4801

Phone

(646) 221-8944

NPI assigned

Jan 14, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Bruce Cooperman, DMD

Title

Secretary

Phone

(646) 221-8944

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1992127765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 W END AVE",
            "address_2": "APT.. 12-A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100255469",
            "telephone_number": "646-221-8944",
            "fax_number": "212-233-8348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W 125TH ST",
            "address_2": "SUITE 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274801",
            "telephone_number": "646-221-8944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "125TH STREET ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "COOPERMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "646-221-8944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "046957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02207707",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 123 Dental Group PC
• 123 Medical Group, P.C.
• 125TH St. Dental Group, PLLC
• 125TH Street Dental Arts P.C.
• 125TH Street Dental LLP
• 128 Central Park South Physicians PLLC
• 128 Plastic Surgery Associates PLLC
• 12TH Street Dental PLLC
• 1317 Medical, P.C.
• 133 Acupuncture P.C.

• Dental Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; 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.