Andrew Ibrahim

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

061190-01 Issued in NY

Practice address

403 Merrick Ave
East Meadow, NY 11554-2200

Phone

(516) 308-9244

NPI assigned

May 14, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631923200000",
    "number": "1497311682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 NEWCASTLE AVE",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118032705",
            "telephone_number": "516-652-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MERRICK AVE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115542200",
            "telephone_number": "516-308-9244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Old Country Rd Ste 460",
            "address_purpose": "LOCATION",
            "city": "Mineola",
            "state": "NY",
            "postal_code": "115014293",
            "country_code": "US",
            "telephone_number": "516-663-1152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-14",
        "last_updated": "2021-09-18",
        "certification_date": "2021-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "061190-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in East Meadow, NY
• Providers in East Meadow, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.

Verify at the official NPI Registry.