Provider Demographics
NPI:1922211408
Name:APTIN GHODS-DJURABCHI, DDS, PC
Entity Type:Organization
Organization Name:APTIN GHODS-DJURABCHI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:APTING
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-733-6600
Mailing Address - Street 1:2505 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4011
Mailing Address - Country:US
Mailing Address - Phone:718-733-6600
Mailing Address - Fax:718-295-0966
Practice Address - Street 1:2505 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4011
Practice Address - Country:US
Practice Address - Phone:718-733-6600
Practice Address - Fax:718-295-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01521833Medicaid