Provider Demographics
NPI:1568604866
Name:SOHAYLA S. ZIVARI
Entity Type:Organization
Organization Name:SOHAYLA S. ZIVARI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIVARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-352-9200
Mailing Address - Street 1:162 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-352-9200
Mailing Address - Fax:845-352-9399
Practice Address - Street 1:162 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3627
Practice Address - Country:US
Practice Address - Phone:845-352-9200
Practice Address - Fax:845-352-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0383511223G0001X
NY0521851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02701540Medicaid
NY00830855Medicaid