Provider Demographics
NPI:1275925992
Name:SOHELI ANAR AZAD DDS PC
Entity Type:Organization
Organization Name:SOHELI ANAR AZAD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SOHELI
Authorized Official - Middle Name:ANAR
Authorized Official - Last Name:AZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-672-5050
Mailing Address - Street 1:9902 220TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1614
Mailing Address - Country:US
Mailing Address - Phone:718-672-5050
Mailing Address - Fax:718-565-5686
Practice Address - Street 1:7017 37TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3922
Practice Address - Country:US
Practice Address - Phone:718-672-5050
Practice Address - Fax:718-565-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831667Medicaid