Healthcare Provider Details

I. General information

NPI: 1407535115
Provider Name (Legal Business Name): ALIREZA SEYFIKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E. 24TH STREET NEW YORK
NEW YORK NY
10010
US

IV. Provider business mailing address

345 E. 24TH STREET NEW YORK
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037356
License Number StateIL
# 2
Primary TaxonomyN
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: