Provider Demographics
NPI:1588813273
Name:REFUAH FAMILY DENTAL P.C
Entity Type:Organization
Organization Name:REFUAH FAMILY DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST (D.D.S)
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:ARASTEHMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-435-3400
Mailing Address - Street 1:5407 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5407 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4128
Practice Address - Country:US
Practice Address - Phone:718-435-3400
Practice Address - Fax:718-436-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01739188Medicaid
NY1530931OtherUNITED CONCORDIA