Provider Demographics
NPI:1851549380
Name:SHOMER ISRAELIAN DDS PC
Entity Type:Organization
Organization Name:SHOMER ISRAELIAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-648-5265
Mailing Address - Street 1:141-02A 70TH ROAD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-648-5265
Mailing Address - Fax:718-758-3563
Practice Address - Street 1:1250 OCEAN PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5155
Practice Address - Country:US
Practice Address - Phone:718-648-5265
Practice Address - Fax:718-758-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty