Provider Demographics
NPI:1821397852
Name:RAFYA SANDHU DENTAL PC
Entity Type:Organization
Organization Name:RAFYA SANDHU DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-676-6673
Mailing Address - Street 1:91 POST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4339
Mailing Address - Country:US
Mailing Address - Phone:516-750-5035
Mailing Address - Fax:516-750-5036
Practice Address - Street 1:91 POST AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4339
Practice Address - Country:US
Practice Address - Phone:516-750-5035
Practice Address - Fax:516-750-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491683Medicaid