Basic Information
Provider Information
NPI: 1447358023
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOLPIN
FirstName: BERNARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5800 3RD AVE
Address2: MANAGED CARE DEPARTMENT
City: BROOKLYN
State: NY
PostalCode: 112203702
CountryCode: US
TelephoneNumber: 7186307477
FaxNumber: 7186307437
Practice Location
Address1: 150 55TH ST
Address2: LMC/FHC DENTAL DEPARTMENT
City: BROOKLYN
State: NY
PostalCode: 112202559
CountryCode: US
TelephoneNumber: 7186306866
FaxNumber: 7184925090
Other Information
ProviderEnumerationDate: 09/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X022984NYY Dental ProvidersDentistGeneral Practice

No ID Information.


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