Provider Demographics
NPI:1003951039
Name:SAROYAN, SIMONA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:SAROYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WESTCHESTER AVE
Mailing Address - Street 2:APT L-20
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3811
Mailing Address - Country:US
Mailing Address - Phone:914-939-2127
Mailing Address - Fax:914-939-2127
Practice Address - Street 1:360 WESTCHESTER AVE
Practice Address - Street 2:APT L-20
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3811
Practice Address - Country:US
Practice Address - Phone:914-939-2127
Practice Address - Fax:914-939-2127
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049823-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02376896Medicaid