Individual provider Active NPI

Nasim Tishbi, DMD

  • Endodontics
  • Plainview, NY
National Provider Identifier
1417453986
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
060771-01 Issued in NY
Practice address
100 Manetto Hill Rd Ste 206
Plainview, NY 11803-1311
Phone
(516) 490-8050
Fax
(516) 490-8051
NPI assigned
Apr 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 060771-01 NY Primary

Addresses

Primary practice location

100 Manetto Hill Rd Ste 206
Plainview, NY 11803-1311

Mailing address

121 Dekalb Ave
Brooklyn, NY 11201-5425

Other practice location 1

79 Landing Ave
Smithtown, NY 11787-2748
Phone (163) 126-5616

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190129000472 NY Order and Referring Only - DentistPractitioner - Dentist 3375880404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
060771-01NYMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Nasim Tishbi DMD PC Endodontics CurrentSince Mar 11, 2025 Accepting new patients

Locations

100 Manetto Hill Rd
Ste 206
Plainview, NY 11803
Phone (516) 490-8050

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, 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": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1417453986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MANETTO HILL RD STE 206",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118031311",
            "telephone_number": "516-490-8050",
            "fax_number": "516-490-8051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 Landing Ave",
            "address_purpose": "LOCATION",
            "city": "Smithtown",
            "state": "NY",
            "postal_code": "117872748",
            "country_code": "US",
            "telephone_number": "163-126-5616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISHBI",
        "first_name": "NASIM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "060771-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainview, NY

Sources for this page

Verify at the official NPI Registry.