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1205819083 NPI number — MOHAMED A ELBASTY DDS, MS, PHDC

NPI Number: 1205819083
Health Care Provider/Practitioner: MOHAMED A ELBASTY DDS, MS, PHDC

Information about “1205819083” NPI (MOHAMED A ELBASTY DDS, MS, PHDC) exists in 1205819083 in HTML format HTML  |  1205819083 in plain Text format TXT  |  1205819083 in PDF (Portable Document Format) PDF  |  1205819083 in an XML format XML  formats.

NPI Number : 1205819083 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205819083",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELBASTY",
    "FirstName": "MOHAMED",
    "MiddleName": "A",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS, MS, PHDC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ELBASTY",
    "OtherFirstName": "M",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "100 COMMONS WAY",
    "SecondLineMailingAddress": "STE 130",
    "MailingAddressCityName": "HOLMDEL",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07733",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-615-0700",
    "MailingAddressFaxNumber": "732-615-9152",
    "FirstLinePracticeLocationAddress": "100 COMMONS WAY",
    "SecondLinePracticeLocationAddress": "STE 130",
    "PracticeLocationAddressCityName": "HOLMDEL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07733",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-615-0700",
    "PracticeLocationAddressFaxNumber": "732-615-9152",
    "EnumerationDate": "11/25/2005",
    "LastUpdateDate": "03/28/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "036877",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "22DI01987400",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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