Healthcare Provider Details

I. General information

NPI: 1861841983
Provider Name (Legal Business Name): KASIM SAYED D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 BROADWAY
AMITYVILLE NY
11701-2761
US

IV. Provider business mailing address

SUNY AT STONY BROOK HOSPITAL DENTISTRY 151 WESTCHESTER HALL
STONY BROOK NY
11794-8711
US

V. Phone/Fax

Practice location:
  • Phone: 631-598-2940
  • Fax:
Mailing address:
  • Phone: 631-444-2557
  • Fax: 631-444-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number059574-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: