Healthcare Provider Details

I. General information

NPI: 1417453986
Provider Name (Legal Business Name): NASIM TISHBI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD STE 206
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 516-490-8050
  • Fax: 516-490-8051
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number060771-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: