=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558939694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROMINA SADRESHKEVARY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2021
-----------------------------------------------------
Last Update Date | 08/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7044 AUSTIN ST
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-367-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 E 30TH ST APT 13E
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-500-5402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 063104-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------