Organization
MADISON AVENUE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLEG DRUT (DOCTOR)
(212) 996-7300
Entity
Organization
Contact information
Practice address
1901 MADISON AVE, NEW YORK, NY 10035-2700
(212) 996-7300
(212) 996-7301
Mailing address
15 ENGLE ST, ENGLEWOOD, NJ 07631-2936
(201) 308-8181
(718) 373-6799
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
047218
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02156105
—
NY
Enumeration date
05/13/2014
Last updated
05/13/2014
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