# 99-04 57TH AVENUE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679977680
- **Authorized official:** DR. MARIA E ACEBO (OWNER)
- **Authorized official phone:** (718) 760-0471

## Contact information

- **Practice address:** 9904 57TH AVE, SUITE LH, CORONA, NY 11368-3746
- **Practice address phone:** (718) 760-0471
- **Practice address fax:** (718) 760-4739
- **Mailing address:** 9904 57TH AVE, SUITE LH, CORONA, NY 11368-3746
- **Mailing address phone:** (718) 760-0471

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0438701 | NY | Yes |

## Other

- **Enumeration date:** 10/20/2014
- **Last updated:** 10/20/2014