Active NPI
Azita Ebrahimzadeh
- Dentist
- Springfield, NJ
National Provider Identifier
1447630488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- E10630710056822
- Practice address
- 291 Mountain Ave
Springfield, NJ 07081-2214 - Phone
- (973) 901-2322
- NPI assigned
- Jun 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | E10630710056822 | NJ | Primary |
Addresses
Primary practice location
291 Mountain Ave
Springfield, NJ 07081-2214
Mailing address
291 Mountain Ave
Springfield, NJ 07081-2214
Phone (973) 901-2322
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 |
|---|---|---|---|
| E10630710056822 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1447630488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "291 MOUNTAIN AVE",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070812214",
"telephone_number": "973-901-2322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "291 MOUNTAIN AVE",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070812214",
"telephone_number": "973-901-2322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBRAHIMZADEH",
"first_name": "AZITA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-04",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "E10630710056822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.