Active NPI
Meriem Boukadoum
- Dentist
- New York, NY
National Provider Identifier
1992104343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50057519
- Practice address
- 520 2ND Ave
Apartment 4C
New York, NY 10016-8640 - Phone
- (703) 955-0668
- NPI assigned
- Aug 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 50057519 | NY | Primary |
Addresses
Primary practice location
520 2ND Ave
Apartment 4C
New York, NY 10016-8640
Mailing address
520 2ND Ave Apt 4C
New York, NY 10016-8619
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160503001522 | NY | Order and Referring Only - Dentist | 1254630825 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50057519 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408579200000",
"number": "1992104343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 2ND AVE APT 4C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100168619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 2ND AVE",
"address_2": "APARTMENT 4C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100168640",
"telephone_number": "703-955-0668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUKADOUM",
"first_name": "MERIEM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-21",
"last_updated": "2014-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "50057519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.