Provider Demographics
NPI:1326544784
Name:EGHBALI, NEDA
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:EGHBALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:151 WESTCHESTER HALL
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8711
Mailing Address - Country:US
Mailing Address - Phone:631-444-2557
Mailing Address - Fax:631-444-6013
Practice Address - Street 1:509 W MERRICK RD STE 103
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5252
Practice Address - Country:US
Practice Address - Phone:516-599-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0605201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program