Provider Demographics
NPI:1821137258
Name:GIRGIS, IMAN NAGY (DDS)
Entity Type:Individual
Prefix:DR
First Name:IMAN
Middle Name:NAGY
Last Name:GIRGIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 DUNHAMS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2624
Mailing Address - Country:US
Mailing Address - Phone:732-698-1070
Mailing Address - Fax:732-698-9464
Practice Address - Street 1:281 SUMMERHILL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4270
Practice Address - Country:US
Practice Address - Phone:732-698-1070
Practice Address - Fax:732-698-9464
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD0205901223G0001X
NY047989-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8845506Medicaid