Provider Demographics
NPI:1376842252
Name:NOURHAN MEKAWY, DDS
Entity Type:Organization
Organization Name:NOURHAN MEKAWY, DDS
Other - Org Name:ISLAND SMILE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOURHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-600-9756
Mailing Address - Street 1:3072 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1344
Mailing Address - Country:US
Mailing Address - Phone:516-520-5858
Mailing Address - Fax:
Practice Address - Street 1:3072 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1344
Practice Address - Country:US
Practice Address - Phone:516-520-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055172-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03273714Medicaid