Islam Moheisen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02829900 Issued in NJ

Practice address

89 N Maple Ave
Ridgewood, NJ 07450-3235

Phone

(201) 797-8899

NPI assigned

Oct 15, 2020

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Jacobi Medical Center

  • Student in an Organized Health Care Education/Training Program
  • Bronx, NY
  • NPI 1972136208
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1477151041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 N MAPLE AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503235",
            "telephone_number": "201-797-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHEISEN",
        "first_name": "ISLAM",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-15",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02829900",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce P Mindich, M.D.
• Robert Dwight Miner, DDS, ROBERT D. MINER, DDS
• Kim R Minervini, PT
• Ibrahim I Mirkhan, DMD
• Malaka Abdellatif Mohamed
• Christine Mohle, LCSW
• Nicole Mohr, PT
• Gaetan Moise, M.D.
• Guillermo J Molina, DDS
• Susan P Molinari, MD

• Dentist in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.