Basic Information
| Provider Information | |||||||||
| NPI: | 1336211564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRUPINSKY | ||||||||
| FirstName: | MELVYN | ||||||||
| MiddleName: | CHESTER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1390 PENNSYLVANIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186428600 | ||||||||
| FaxNumber: | 7189421425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 PENNSYLVANIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186428600 | ||||||||
| FaxNumber: | 7189421425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 026198 | NY | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 00280066 | 05 | NY | MEDICAID |