Provider Demographics
NPI:1023432598
Name:ALJABERI, YASSMIN
Entity type:Individual
Prefix:
First Name:YASSMIN
Middle Name:
Last Name:ALJABERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W 21ST ST
Mailing Address - Street 2:APT 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3423
Mailing Address - Country:US
Mailing Address - Phone:330-265-7399
Mailing Address - Fax:
Practice Address - Street 1:1201 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3037
Practice Address - Country:US
Practice Address - Phone:330-265-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024066122300000X
NY0582041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry