Provider Demographics
NPI:1265661300
Name:EL-HALABY, AHMED (DDS MSD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:EL-HALABY
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 FAIRPORT NINE MILE POINT RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1749
Mailing Address - Country:US
Mailing Address - Phone:585-377-5810
Mailing Address - Fax:585-377-1121
Practice Address - Street 1:1484 STATE ROUTE 332 STE 6
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9161
Practice Address - Country:US
Practice Address - Phone:585-389-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577451223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04351777Medicaid