Individual provider Active NPI

Saleh A Elahwal

  • Dentist
  • Brooklyn, NY
National Provider Identifier
1184633190
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
042462 Issued in NY
Practice address
481 83Rd St
Brooklyn, NY 11209-4512
Phone
(718) 748-1122
Fax
(718) 748-9400
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 042462 NY
Dentist 122300000X 042462 NY Primary

Addresses

Primary practice location

481 83Rd St
Brooklyn, NY 11209-4512

Mailing address

481 83Rd St
Brooklyn, NY 11209-4512
Phone (718) 748-1122

Other identifiers 1

IdentifierTypeStateIssuer
01161471MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230428002313 NY Practitioner - Maxillofacial SurgeryPractitioner - Oral SurgeryPractitioner - DentistPractitioner - Sleep Medicine 1951620426

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
042462NYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ez Sleep Care, LLC Dentist CurrentSince Dec 12, 2018 Accepting new patients

Locations

481 83rd St
Fl 2
Brooklyn, NY 11209
Phone (718) 748-1122

481 83rd St
Brooklyn, NY 11209
Phone (718) 748-1122

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1184633190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 83RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094512",
            "telephone_number": "718-748-1122",
            "fax_number": "718-748-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 83RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094512",
            "telephone_number": "718-748-1122",
            "fax_number": "718-748-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAHWAL",
        "first_name": "SALEH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "042462",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "042462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01161471",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.