Active NPI
Babak Movaghar, D.D.S.
- Dentist
- Suffern, NY
National Provider Identifier
1104086669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 057127
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150514001509 | NJ | Order and Referring Only - Oral Surgery | 5294055299 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.027495 | IL | MD | Dentist |
| 057127 | NY | MD | Pharmacist |
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.