Active NPI
Jasmine A Ghanem, DMD
- Pediatric Dentistry
- Brooklyn, NY
National Provider Identifier
1205459500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 062281
- Practice address
- 5800 3Rd Ave
Brooklyn, NY 11220-3702 - Phone
- (718) 630-0100
- NPI assigned
- May 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 062281 | NY | Primary |
Addresses
Primary practice location
5800 3Rd Ave
Brooklyn, NY 11220-3702
Mailing address
469 Jefferson Ave
Staten Island, NY 10306-5430
Phone (917) 497-4337
Other practice location 1
2076 Hylan Blvd
Staten Island, NY 10306-3427
Phone (347) 470-4503
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231004001927 | NY | Order and Referring Only - Dentist | 4688029077 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062281 | NY | MD | Clinical Social Worker |
Interoperability endpoints
- jghanem457702@nyumc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714694400000",
"number": "1205459500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "469 JEFFERSON AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103065430",
"telephone_number": "917-497-4337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5800 3RD AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112203702",
"telephone_number": "718-630-0100"
}
],
"practiceLocations": [
{
"address_1": "2076 Hylan Blvd",
"address_purpose": "LOCATION",
"city": "Staten Island",
"state": "NY",
"postal_code": "103063427",
"country_code": "US",
"telephone_number": "347-470-4503",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GHANEM",
"first_name": "JASMINE",
"middle_name": "A",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-20",
"last_updated": "2024-05-03",
"certification_date": "2023-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "062281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; 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.