Basic Information
Provider Information
NPI: 1447606587
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHO
FirstName: STACY
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 204 DOGWOOD RD
Address2:  
City: ROSLYN
State: NY
PostalCode: 115763015
CountryCode: US
TelephoneNumber: 5162706272
FaxNumber:  
Practice Location
Address1: 2211 MERRICK RD
Address2:  
City: MERRICK
State: NY
PostalCode: 115664752
CountryCode: US
TelephoneNumber: 5163655439
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2016
LastUpdateDate: 10/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0221X059992-1NYY Dental ProvidersDentistPediatric Dentistry

No ID Information.


Home