Provider Demographics
NPI:1629151691
Name:ELSAFTY, TAREK Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:Y
Last Name:ELSAFTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 LOBOS LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-6825
Mailing Address - Country:US
Mailing Address - Phone:201-213-1961
Mailing Address - Fax:
Practice Address - Street 1:24 GROTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2014
Practice Address - Country:US
Practice Address - Phone:607-344-0052
Practice Address - Fax:607-344-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02552032Medicaid