Provider Demographics
NPI:1922430875
Name:GHOBASHY, IBRAHIM MOSTAFA (DENTAL DEGREE DDS)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:MOSTAFA
Last Name:GHOBASHY
Suffix:
Gender:M
Credentials:DENTAL DEGREE DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 ASYLUM AVE
Mailing Address - Street 2:4L
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2435
Mailing Address - Country:US
Mailing Address - Phone:860-249-4717
Mailing Address - Fax:
Practice Address - Street 1:357 BROADWAY
Practice Address - Street 2:STE 2E
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2748
Practice Address - Country:US
Practice Address - Phone:631-789-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist