MEDICARE: MR. NILE ISMAIL DDS

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	390200000X	Student in an Organized Health Care Education/Training Program	1275237190	NY

General Provider Information

NPI Number	:	1275237190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NILE ISMAIL DDS

Provider Business Mailing Address
First Line	:	1775 GRAND CONCOURSE FL 6
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-8202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 GRAND CONCOURSE FL 6
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-8202
Country	:	US
Telephone Number	:	718-901-8400
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	05/20/2026

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