MEDICARE: DR. MATTHEW GHADAMI 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	1223G0001X	General Practice Dentistry	050254	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316931561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW GHADAMI DDS

Provider Business Mailing Address
First Line	:	24902 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-4023
Country	:	US
Telephone Number	:	516-354-1700
Fax Number	:	516-354-4845

Provider Business Practice Location Address
First Line	:	24902 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-4023
Country	:	US
Telephone Number	:	516-354-1700
Fax Number	:	516-354-4845

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/29/2016

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