Individual
DR. HAZEM ELBIALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
107 PROSPECT ST STE 1, SCHOHARIE, NY 12157-3204
(518) 702-4145
Mailing address
PO BOX 129, SCHOHARIE, NY 12157-0129
(518) 702-4145
(518) 702-4195
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
056403
NY
1223G0001X
General Practice Dentistry
Primary
056403
NY
1223G0001X
General Practice Dentistry
DN1855804
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03503275
—
NY
Enumeration date
08/23/2011
Last updated
11/22/2015
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