Provider Demographics
NPI:1366949257
Name:IBRAHEEM, SUMAYA (DDS)
Entity type:Individual
Prefix:
First Name:SUMAYA
Middle Name:
Last Name:IBRAHEEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NOSTRAND AVE APT 7F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4724
Mailing Address - Country:US
Mailing Address - Phone:347-216-6250
Mailing Address - Fax:
Practice Address - Street 1:286 MADISON AVE STE 1803
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6368
Practice Address - Country:US
Practice Address - Phone:212-683-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0605011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice