Individual provider Active NPI

Babak Movaghar, D.D.S.

  • Dentist
  • Suffern, NY
National Provider Identifier
1104086669
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
057127 Issued in NY
Practice address
7 Hemion Rd
Suffern, NY 10901-4919
Phone
(845) 357-3244
Fax
(845) 357-3251
NPI assigned
Jun 9, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.027495 IL
Dentist 122300000X 057127 NY Primary

Addresses

Primary practice location

7 Hemion Rd
Suffern, NY 10901-4919

Mailing address

4235 W North Ave
Chicago, IL 60639-4852
Phone (312) 622-0854

Other practice location 1

4235 W North Ave
Chicago, IL 60639-4852
Phone (773) 276-3360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150514001509 NJ Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5294055299

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.027495ILMDDentist
057127NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1104086669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394852",
            "telephone_number": "312-622-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 HEMION RD",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109014919",
            "telephone_number": "845-357-3244",
            "fax_number": "845-357-3251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4235 W North Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606394852",
            "country_code": "US",
            "telephone_number": "773-276-3360",
            "fax_number": "773-276-4032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOVAGHAR",
        "first_name": "BABAK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.027495",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "057127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffern, NY

Sources for this page

Verify at the official NPI Registry.