Healthcare Provider Details

I. General information

NPI: 1194040782
Provider Name (Legal Business Name): MOHAMMAD TOFIGH D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 02/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL DEPT ORAL AND MAXILLOFACIAL SURGERY
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL DEPT ORAL AND MAXILLOFACIAL SURGERY
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 347-590-9910
  • Fax:
Mailing address:
  • Phone: 347-590-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14666
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number058649
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number291460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: