Jessica Barzideh, DMD
Individual provider Active NPI Dentist · Albertson, NY
NPI 1326326430 · NPPES record last updated Jul 29, 2014
Key facts
- NPI
- 1326326430
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 055568 (NY)
- Practice address
- 27 Woodville LN
Albertson, NY 11507-1111 - Phone
- (516) 484-9470
- NPI assigned
- Jul 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111115000434 | NY | Order and Referring Only - Oral Surgery |
0345414058 | |
| I20160429001722 | NY | Order and Referring Only - Dentist |
0345414058 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055568 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rooted Pediatric Dental | Current | Accepting new patients | |
| New York City Health and Hospitals Corporation | Past | Accepting new patients |
Locations
265 Post Ave
Ste 380
Westbury, NY 11590
Phone (516) 334-9385
Interoperability endpoints
- jbarzideh562936@nychhc.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 055568 | NY | Yes |
Addresses
Primary practice location
27 Woodville LN
Albertson, NY 11507-1111
Mailing address
27 Woodville LN
Albertson, NY 11507-1111
Phone (516) 455-3308
Other providers in Albertson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.