Healthcare Provider Details

I. General information

NPI: 1225400583
Provider Name (Legal Business Name): SHERIF DESOUKY DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 MAIN ST STE 1
FARMINGDALE NY
11735-5426
US

IV. Provider business mailing address

918 MAIN ST STE 1
FARMINGDALE NY
11735-5426
US

V. Phone/Fax

Practice location:
  • Phone: 516-420-1177
  • Fax: 516-454-7897
Mailing address:
  • Phone: 516-420-1177
  • Fax: 516-454-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number043061
License Number StateNY

VIII. Authorized Official

Name: SHERIF DESOUKY
Title or Position: DOCTOR
Credential:
Phone: 516-420-1177