Elite New York Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

053887-1 Issued in NY

Legal business name

ELITE NEW YORK DENTAL

Practice address

4305 48TH Ave
Woodside, NY 11377-6241

Phone

(347) 420-9490

Fax

(201) 963-3805

NPI assigned

Dec 29, 2008

Organization subpart

No

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

Authorized official

Name

Mark Mehrdad Hagigi, DDS

Title

President

Phone

(347) 420-9490

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1174769970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43-05 48TH AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113776241",
            "telephone_number": "347-420-9490",
            "fax_number": "201-963-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 48TH AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113776241",
            "telephone_number": "347-420-9490",
            "fax_number": "201-963-3805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE NEW YORK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-29",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "HAGIGI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "MEHRDAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-420-9490",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "053887-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Woodside, NY
• Providers in Woodside, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.