Provider Demographics
NPI:1730231648
Name:RABANIPOUR, SOLEIMAN
Entity type:Individual
Prefix:
First Name:SOLEIMAN
Middle Name:
Last Name:RABANIPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 MALCOLM X BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1813
Mailing Address - Country:US
Mailing Address - Phone:212-694-7983
Mailing Address - Fax:212-694-7957
Practice Address - Street 1:527 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1813
Practice Address - Country:US
Practice Address - Phone:212-694-7983
Practice Address - Fax:212-694-7957
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01264680Medicaid