Hazem Elbialy, DMD
Individual provider Active NPI General Practice Dentistry · Schoharie, NY
NPI 1629358569 · NPPES record last updated Nov 22, 2015
Key facts
- NPI
- 1629358569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 056403 (NY)
- Practice address
- 107 Prospect St Ste 1
Schoharie, NY 12157-3204 - Phone
- (518) 702-4145
- NPI assigned
- Aug 23, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| I20151203000901 | NY | Order and Referring Only - Dentist |
2365742905 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1855804 | MA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 056403 | NY | |
| General Practice Dentistry | 1223G0001X | DN1855804 | MA | |
| General Practice Dentistry | 1223G0001X | 056403 | NY | Yes |
Addresses
Primary practice location
107 Prospect St Ste 1
Schoharie, NY 12157-3204
Mailing address
PO Box 129
Schoharie, NY 12157-0129
Phone (518) 702-4145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03503275 | Medicaid | NY |
Other providers in Schoharie, NY
- Eric Christopher Davis
- Diane Degiovine
- Shannon Nicole Degroff
- Eugene Dinuzzo
- Courteny Dowsey
- Kelly B Farnan
- Karen Lynn Frankel
- Cynthia Winslow Godbout
- Sheila Charlene Gorton
- Grace M Hathaway
All providers in Schoharie, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2015. 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.