Provider Demographics
NPI:1477006476
Name:BARRY ELAAHI, DDS, PC
Entity Type:Organization
Organization Name:BARRY ELAAHI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-641-7028
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-352-0520
Mailing Address - Fax:
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-352-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056515-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03830628Medicaid