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General NPI Number Information
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NPI Number | 1548882574
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Entity Type | Individual
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Provider Name | MICHELLE RABIZADEH
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4422 3RD AVE
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City | BRONX
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State | NY
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Zip | 10457-2545
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Country | US
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Telephone | 718-960-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 19 CRICKETT LN
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City | GREAT NECK
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State | NY
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Zip | 11024-1004
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Country | US
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Telephone | 516-320-9978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 061980
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License Number State | NY
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