Basic Information
| Provider Information | |||||||||
| NPI: | 1891130571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SABZWARI | ||||||||
| FirstName: | ALEENA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1220 | ||||||||
| Address2: | ATTN: CREDENTIALING/HR | ||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088621220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323766635 | ||||||||
| FaxNumber: | 7323245765 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 HOBART ST | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088613396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323769333 | ||||||||
| FaxNumber: | 7323245765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 22DI02541700 | NJ | Y | Dental Providers | Dentist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 0425401 | 05 | NJ | MEDICAID |