=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275195539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEDA RAZEAH SHAHRABI DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2019
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 SHAWNEE RD
-----------------------------------------------------
City | HOPATCONG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07843-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-398-6680
-----------------------------------------------------
Fax | 973-398-6750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 SHAWNEE RD
-----------------------------------------------------
City | HOPATCONG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07843-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-655-6295
-----------------------------------------------------
Fax | 973-397-6750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI02878800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | UNKNOWN
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------