Minoo Dilmanian, DMD
Individual provider Active NPI Dentist · Great Neck, NY
NPI 1508067943 · NPPES record last updated May 20, 2014
Key facts
- NPI
- 1508067943
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 038394 (NY)
- Practice address
- 19 Laurel Dr
Great Neck, NY 11021-2919 - Phone
- (516) 829-4247
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151218000190 | NY | Order and Referring Only - Dentist |
7810298700 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 038394 | NY | Yes |
Addresses
Primary practice location
19 Laurel Dr
Great Neck, NY 11021-2919
Mailing address
19 Laurel Dr
Great Neck, NY 11021-2919
Phone (845) 562-2828
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00980534 | Medicaid | NY |
Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.