Active NPI
Nedjat Baravarian
- General Practice Dentistry
- Elmhurst, NY
National Provider Identifier
1457552838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 040454-1
- Practice address
- 8710 Grand Ave
Elmhurst, NY 11373-4444 - Phone
- (718) 429-8300
- NPI assigned
- May 31, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 040454-1 | NY | Primary |
Addresses
Primary practice location
8710 Grand Ave
Elmhurst, NY 11373-4444
Mailing address
6561 Saunders St
Rego Park, NY 11374-4252
Phone (516) 625-4204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00981728 | Medicaid | NY |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040454-1 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jules V. Lane, DDS | General Practice | Past | 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.
-
- General Practice Dentistry
- Elmhurst, NY
- NPI 1659360881
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388016000000",
"number": "1457552838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6561 SAUNDERS ST",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113744252",
"telephone_number": "516-625-4204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8710 GRAND AVE",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734444",
"telephone_number": "718-429-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARAVARIAN",
"first_name": "NEDJAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2013-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "040454-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00981728",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.