Healthcare Provider Details

I. General information

NPI: 1396575064
Provider Name (Legal Business Name): MARIAM GHOBRIAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date: 05/13/2025
Reactivation Date: 07/28/2026

III. Provider practice location address

FLUSHING HOSPITAL MEDICAL CENTER 4500 PARSONS BLVD
FLUSHING NY
11355
US

IV. Provider business mailing address

FLUSHING HOSPITAL MEDICAL CENTER 4500 PARSONS BLVD
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-5000
  • Fax:
Mailing address:
  • Phone: 718-670-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: