Active NPI
Ariela Mullukandov, DDS
- General Practice Dentistry
- Rego Park, NY
National Provider Identifier
1578200093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 063219
- Practice address
- 9424 63Rd Dr
Rego Park, NY 11374-2028 - Phone
- (718) 997-7762
- NPI assigned
- May 16, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 063219 | NY | Primary |
Addresses
Primary practice location
9424 63Rd Dr
Rego Park, NY 11374-2028
Mailing address
6625 103Rd St Apt 3L
Forest Hills, NY 11375-2023
Phone (917) 538-3432
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 |
|---|---|---|---|
| 063219 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717286400000",
"number": "1578200093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6625 103RD ST APT 3L",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113752023",
"telephone_number": "917-538-3432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9424 63RD DR",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742028",
"telephone_number": "718-997-7762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLUKANDOV",
"first_name": "ARIELA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-16",
"last_updated": "2024-06-02",
"certification_date": "2024-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "063219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rego Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.