Healthcare Provider Details

I. General information

NPI: 1518764018
Provider Name (Legal Business Name): NASIM TISHBI DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
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

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

V. Phone/Fax

Practice location:
  • Phone: 718-490-8050
  • Fax:
Mailing address:
  • Phone: 718-290-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. NASIM TISHBI
Title or Position: ENDODONTIST
Credential: DMD
Phone: 718-290-5668