Maryam Mahdavi, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

060887-01 Issued in NY

Practice address

978 Rockaway Ave
Valley Stream, NY 11581-2136

Phone

(617) 909-6118

NPI assigned

Mar 25, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bronxcare Dr. Martin Luther King Jr. Health Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
  • NPI 1437231693
  NPD (past)

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1851753156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 FAIRVIEW AVE",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024783766",
            "telephone_number": "617-909-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "978 ROCKAWAY AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115812136",
            "telephone_number": "617-909-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHDAVI",
        "first_name": "MARYAM",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "060887-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Maas, LMHC
• Eloisa Gimenez Macapagal, PT
• Christina M Mach, RPH
• Madame Jay Salon LLC
• John Magli, RPH
• Manal Mahdy, PT
• Nadir Mahmood
• Mahon Physical Therapy PC
• Marie H G Maignan
• Madiha Majid, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.