Organization
125TH STREET ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BRUCE COOPERMAN DMD (SECRETARY)
(646) 221-8944
Entity
Organization
Contact information
Practice address
360 W 125TH ST, SUITE 8, NEW YORK, NY 10027-4801
(646) 221-8944
Mailing address
789 W END AVE, APT.. 12-A, NEW YORK, NY 10025-5469
(646) 221-8944
(212) 233-8348
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
046957
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207707
—
NY
Enumeration date
01/14/2014
Last updated
01/14/2014
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