Healthcare Provider Details

I. General information

NPI: 1992185508
Provider Name (Legal Business Name): MARYAM HASHEMI, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N CENTRAL AVE SUITE 460
HARTSDALE NY
10530-1832
US

IV. Provider business mailing address

280 N CENTRAL AVE SUITE 460
HARTSDALE NY
10530-1832
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-4949
  • Fax: 914-949-8727
Mailing address:
  • Phone: 914-949-4949
  • Fax: 914-949-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number039259-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARYAM HASHEMI
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 914-949-4949