Basic Information
| Provider Information | |||||||||
| NPI: | 1427302173 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOHELI ANAR AZAD DDS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9902 220TH ST | ||||||||
| Address2: | PVT HOUSE | ||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114291614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186725050 | ||||||||
| FaxNumber: | 7185655686 | ||||||||
| Practice Location | |||||||||
| Address1: | 7017 37TH AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113723922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186725050 | ||||||||
| FaxNumber: | 7185655686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 11/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | AZAD | ||||||||
| AuthorizedOfficialFirstName: | SOHELI | ||||||||
| AuthorizedOfficialMiddleName: | ANAR | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7186725050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 047363 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1093924755 | 01 | NY | SOLE PROPEITOR NPI | OTHER | 01831667 | 05 | NY | MEDICAID |