Individual provider Active NPI

Louis P Amendolagine, DDS

  • General Practice Dentistry
  • Salisbury Mills, NY
National Provider Identifier
1053408393
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0387631 Issued in NY
Practice address
2169 Rte 94
Salisbury Mills, NY 12577
Phone
(845) 496-4710
Fax
(845) 496-5359
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0387631 NY Primary

Addresses

Primary practice location

2169 Rte 94
Salisbury Mills, NY 12577

Mailing address

2169 Rte 94
Salisbury Mills, NY 12577
Phone (845) 496-4710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160616001320 NY Order and Referring Only - DentistPractitioner - Dentist 4385935691

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0387631NYMDGeneral Practice Dentistry
038763NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053408393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2169 RTE 94",
            "city": "SALISBURY MILLS",
            "state": "NY",
            "postal_code": "12577",
            "telephone_number": "845-496-4710",
            "fax_number": "845-496-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2169 RTE 94",
            "city": "SALISBURY MILLS",
            "state": "NY",
            "postal_code": "12577",
            "telephone_number": "845-496-4710",
            "fax_number": "845-496-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMENDOLAGINE",
        "first_name": "LOUIS",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0387631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury Mills, NY

Sources for this page

Verify at the official NPI Registry.