Healthcare Provider Details

I. General information

NPI: 1912706136
Provider Name (Legal Business Name): ARIELLA FARAHMANDPOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MINEOLA BLVD
MINEOLA NY
11501-2420
US

IV. Provider business mailing address

103 GILMAR LN
ROSLYN HEIGHTS NY
11577-2304
US

V. Phone/Fax

Practice location:
  • Phone: 516-248-3623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: