Active NPI
Mostafa Ibrahim, BDS,PROSTHODONTIST
- Dentist
- Rahway, NJ
National Provider Identifier
1336818665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019033395
- Practice address
- 1 Carriage City PLZ Apt 1105
Rahway, NJ 07065-5185 - Phone
- (609) 968-8353
- NPI assigned
- Sep 9, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901601119 | MI | |
| Dentist | 122300000X | 019033395 | IL | Primary |
Addresses
Primary practice location
1 Carriage City PLZ Apt 1105
Rahway, NJ 07065-5185
Mailing address
1 Carriage City PLZ Apt 1105
Rahway, NJ 07065-5185
Phone (609) 968-8353
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2901601119APP21 | Medicaid | MI | |
| 019033395 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019033395 | IL | MD | Dentist |
| 2901601119 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Des-Way Dental Group PLLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Homewood, IL
- NPI 1679439160
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1336818665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CARRIAGE CITY PLZ APT 1105",
"city": "RAHWAY",
"state": "NJ",
"postal_code": "070655185",
"telephone_number": "609-968-8353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CARRIAGE CITY PLZ APT 1105",
"city": "RAHWAY",
"state": "NJ",
"postal_code": "070655185",
"telephone_number": "609-968-8353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "MOSTAFA",
"credential": "BDS,PROSTHODONTIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-09",
"last_updated": "2021-09-09",
"certification_date": "2021-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901601119",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019033395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2901601119APP21",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019033395",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rahway, NJ
- Holsman Physical and Occupational Therapy PC
- Holsman Physical and Occupational Therapy, PC
- Holsman Wellness Center PC
- Matthew Robert Hosler, M.D.
- Hugh'S Angels Transportation L.L.C
- Osarumen Igbinosun, DPT
- Ngozi Chinonye Bianca Igwe
- Victoria Ike, PA-C
- Innovative Dentistry, P.C.
- Institute for Hypertension and Kidney Diseases PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.