Provider Demographics
NPI:1760529499
Name:HERSINI, SIAMAK N (DMD)
Entity type:Individual
Prefix:DR
First Name:SIAMAK
Middle Name:N
Last Name:HERSINI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S. ASTOR SR.
Mailing Address - Street 2:APT 504
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533
Mailing Address - Country:US
Mailing Address - Phone:914-261-1650
Mailing Address - Fax:315-781-1297
Practice Address - Street 1:1 S. ASTOR SR.
Practice Address - Street 2:APT 504
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533
Practice Address - Country:US
Practice Address - Phone:914-261-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00206399122300000X
METLD52851223G0001X, 122300000X
CODEN.002063991223G0001X
NY0488271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146138Medicaid