Active NPI
Alex Montazem, DMD
- Oral and Maxillofacial Surgery (Dentist)
- Smithtown, NY
National Provider Identifier
1730230574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 042730
- Practice address
- 285 E Main St Ste 108
Smithtown, NY 11787-2912 - Phone
- (631) 265-9700
- Fax
- (631) 265-9703
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 042730 | NY | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 042730 | NY | Primary |
Addresses
Primary practice location
285 E Main St Ste 108
Smithtown, NY 11787-2912
Mailing address
285 E Main St Ste 108
Smithtown, NY 11787-2912
Phone (631) 265-9700
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1364282 | Other | UNITED HEALTHCARE | |
| P3492579 | Other | OXFORD | |
| 116561 | Other | CIGNA DMO | |
| 0565561 | Other | NY | GHI MEDICAL |
| 522421P | Other | NY | HIP |
| D99121 | Other | EMPIRE BCBS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042730 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1730230574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "285 E MAIN ST STE 108",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872912",
"telephone_number": "631-265-9700",
"fax_number": "631-265-9703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "285 E MAIN ST STE 108",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872912",
"telephone_number": "631-265-9700",
"fax_number": "631-265-9703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTAZEM",
"first_name": "ALEX",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "NY",
"license": "042730",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NY",
"license": "042730",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1364282",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3492579",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA DMO",
"identifier": "116561",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI MEDICAL",
"identifier": "0565561",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "522421P",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BCBS",
"identifier": "D99121",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.