Healthcare Provider Details

I. General information

NPI: 1831453877
Provider Name (Legal Business Name): RITA MIZRAHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 BRUSH HOLLOW RD STE 102
WESTBURY NY
11590-1778
US

IV. Provider business mailing address

959 BRUSH HOLLOW RD STE 102
WESTBURY NY
11590-1778
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-5900
  • Fax:
Mailing address:
  • Phone: 516-333-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02506100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50 058683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: