NPIMap

Organization Active NPI

Wisdom Tooth of Lindenhurst

  • Dentist
  • Lindenhurst, NY
National Provider Identifier
1013184605
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
035654 Issued in NY
Legal business name
WISDOM TOOTH OF LINDENHURST
Practice address
600D N Wellwood Ave
Lindenhurst, NY 11757
Phone
(631) 225-1900
Fax
(631) 225-1904
NPI assigned
May 13, 2008
Last updated
May 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael H Kantrowitz, DMDNPI 1801008008
Title
Owner
Phone
(631) 225-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 035654 NY Primary

Addresses

Primary practice location

600D N Wellwood Ave
Lindenhurst, NY 11757

Mailing address

600D N Wellwood Ave
Lindenhurst, NY 11757
Phone (631) 225-1900

Other identifiers 1

IdentifierTypeStateIssuer
00632820MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
The Wisdom Tooth of Lindenhurst2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1013184605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600D N WELLWOOD AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "11757",
            "telephone_number": "631-225-1900",
            "fax_number": "631-225-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600D N WELLWOOD AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "11757",
            "telephone_number": "631-225-1900",
            "fax_number": "631-225-1904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISDOM TOOTH OF LINDENHURST",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "KANTROWITZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-225-1900",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "035654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00632820",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.