Organization Active NPI

Morris Avenue Children & Adult Dentistry

  • General Practice Dentistry
  • Bronx, NY
National Provider Identifier
1255538120
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
045772 Issued in NY
Legal business name
MORRIS AVENUE CHILDREN & ADULT DENTISTRY
Practice address
1037 Morris Ave
Bronx, NY 10456-5816
Phone
(718) 293-8005
Fax
(718) 681-5515
NPI assigned
Jul 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Shahroukh Yaghoubian, DDSNPI 1407837594
Title
President
Phone
(718) 293-8005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 045772 NY Primary

Addresses

Primary practice location

1037 Morris Ave
Bronx, NY 10456-5816

Mailing address

1037 Morris Ave
Bronx, NY 10456-5816
Phone (718) 293-8005

Other identifiers 1

IdentifierTypeStateIssuer
01668193MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255538120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104565816",
            "telephone_number": "718-293-8005",
            "fax_number": "718-681-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104565816",
            "telephone_number": "718-293-8005",
            "fax_number": "718-681-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORRIS AVENUE CHILDREN & ADULT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YAGHOUBIAN",
        "authorized_official_first_name": "SHAHROUKH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-293-8005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01668193",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.