Basic Information
| Provider Information | |||||||||
| NPI: | 1770109589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPIRE STATE ORTHODONTICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 DARTMOUTH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021165297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788463303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2840 MILITARY RD | ||||||||
| Address2: | |||||||||
| City: | NIAGARA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 143041566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162853588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2020 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | DIMAGGIO | ||||||||
| AuthorizedOfficialFirstName: | MARGEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF INTEGRATIN | ||||||||
| AuthorizedOfficialTelephone: | 9788463303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.