Basic Information
| Provider Information | |||||||||
| NPI: | 1235273202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANCIS DEFALCO DENT CL DISB | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BFFY- DEFALCO DENTAL CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 JORALEMON ST | ||||||||
| Address2: | 9 FL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 7187226219 | ||||||||
| Practice Location | |||||||||
| Address1: | 11-29 CATHERINE STR | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183885900 | ||||||||
| FaxNumber: | 7183883927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CORRADO | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7187226123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 00290822 | 05 | NY | MEDICAID |