Healthcare Provider Details

I. General information

NPI: 1659788008
Provider Name (Legal Business Name): 116 STREET DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W 116TH ST GROUND FLOOR
NEW YORK NY
10026-2431
US

IV. Provider business mailing address

240 W 116TH ST GROUND FLOOR
NEW YORK NY
10026-2431
US

V. Phone/Fax

Practice location:
  • Phone: 347-331-6681
  • Fax:
Mailing address:
  • Phone: 347-331-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number056883
License Number StateNY

VIII. Authorized Official

Name: DR. AHMED S BEHEIRY
Title or Position: DENTIST
Credential: DDS
Phone: 718-573-3333