Provider Demographics
NPI:1780886473
Name:JALBOUT, ZIAD (DDS)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:
Last Name:JALBOUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 61ST ST APT 10G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7611
Mailing Address - Country:US
Mailing Address - Phone:646-825-1614
Mailing Address - Fax:646-478-9796
Practice Address - Street 1:67 PARK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2557
Practice Address - Country:US
Practice Address - Phone:646-484-0197
Practice Address - Fax:646-478-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022219001223G0001X
NY052597-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice