Provider Demographics
NPI:1811172372
Name:MOHAMMAD M. BILLAH PC
Entity type:Organization
Organization Name:MOHAMMAD M. BILLAH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:MOTASIM
Authorized Official - Last Name:BILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS (DENTIST)
Authorized Official - Phone:718-384-0010
Mailing Address - Street 1:302 BROADWAY
Mailing Address - Street 2:302 BROADWAY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7308
Mailing Address - Country:US
Mailing Address - Phone:718-384-0010
Mailing Address - Fax:718-599-4632
Practice Address - Street 1:302 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7308
Practice Address - Country:US
Practice Address - Phone:718-384-0010
Practice Address - Fax:718-599-4632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMAD M. BILLAH PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00374841Medicaid