Provider Demographics
NPI:1073720181
Name:IBRAHIM, SHERINE (DDS06)
Entity Type:Individual
Prefix:DR
First Name:SHERINE
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DDS06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3314
Mailing Address - Country:US
Mailing Address - Phone:914-961-4613
Mailing Address - Fax:
Practice Address - Street 1:434 ALBEE SQ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5306
Practice Address - Country:US
Practice Address - Phone:718-858-9211
Practice Address - Fax:516-822-2396
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038931-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01337324Medicaid