MEDICARE: DR. LEELA B GHAFFARI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	050479	NY

General Provider Information

NPI Number	:	1174798219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEELA B GHAFFARI DMD

Provider Business Mailing Address
First Line	:	60 E END AVE APT 38A
Second Line	:	38A
City	:	NEW YORK
State	:	NY
Zip	:	10028-7908
Country	:	US
Telephone Number	:	212-734-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 E END AVE APT 38A
Second Line	:	38A
City	:	NEW YORK
State	:	NY
Zip	:	10028-7908
Country	:	US
Telephone Number	:	212-734-3355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	02/10/2012

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