Melia Julia Abou-Hanna, DDS
Individual provider Active NPI General Practice Dentistry · Peoria, IL
NPI 1083300552 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1083300552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 22D103021000 (NJ)
- Practice address
- 2903 Rushford CT
Peoria, IL 61614-1145 - Phone
- (309) 265-6488
- NPI assigned
- Apr 17, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250124002255 | NY | Practitioner - Dentist | 1850820549 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22D103021000 | NJ | MD | General Practice Dentistry |
| 064075 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Century Medical & Dental Center Inc | Current |
Accepting new patients | |
| Suny Downstate Medical Center | Past | Accepting new patients |
Locations
260 Avenue X
Brooklyn, NY 11223
Phone (718) 336-8855
827 11th Ave
New York, NY 10019
Phone (212) 257-9778
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22D103021000 | NJ | Yes |
| General Practice Dentistry | 1223G0001X | 064075 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2903 Rushford CT
Peoria, IL 61614-1145
Mailing address
625 W 57TH St Apt 1419
New York, NY 10019-2663
Phone (309) 265-6488
Other practice location 1
118 Washington St
Hoboken, NJ 07030-4649
Phone (201) 329-4145
Other providers in Peoria, IL
- Elizabeth Omotayo Abe
- Arabelle Abellard
- Kylie Taylor Abney
- Makram Abou Ghaida
- Jawad Elia Abou Zeid
- May Awad Abouhouli
- Bassel Elia Abouzeid
- Hrudya Abraham
- Susan Abraham
- Kelly Abrams
All providers in Peoria, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.