Healthcare Provider Details

I. General information

NPI: 1477296325
Provider Name (Legal Business Name): AURASH DAVID ABRISHAMCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12402 METROPOLITAN AVE
KEW GARDENS NY
11415-2712
US

IV. Provider business mailing address

27 OLD FARM RD
GREAT NECK NY
11020-1319
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-2291
  • Fax:
Mailing address:
  • Phone: 516-587-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number063427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: