Payam Mirfendereski

Primary specialty

DentistTaxonomy code 122300000X

License

063834 Issued in NY

Practice address

345 E 24TH St
New York, NY 10010-4020

Phone

(212) 998-9743

Fax

(212) 995-4767

NPI assigned

Mar 26, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: pmirfendereski733272@nyumc.direct-ci.com

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.

• Northstate Dental

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1619758091
  NPD (past)
• Northstate Dental University Program

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1588498133
  NPD (past)

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1912584764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 E 24TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100104020",
            "telephone_number": "212-998-9743",
            "fax_number": "212-995-4767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E 24TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100104020",
            "telephone_number": "212-998-9743",
            "fax_number": "212-995-4767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRFENDERESKI",
        "first_name": "PAYAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125Q00000X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral Medicine",
            "state": "NY",
            "license": "063834",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106713",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "063834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Mire Rose, LMT, RYT
• Ilona Mirecki, M.D.
• Julia Mirer, M.D.
• Marc Miresco, MD
• Shir Miretzky, DO
• Niloofar Mirhadi
• Michael Mirham
• Miray E Mirham, MD
• Rebecca Mirhashem
• Miriam Martinez, PHD, Psychologist, PLLC

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.