Active NPI
Patrick Micaroni
- Pediatric Dentistry
- New Hartford, NY
National Provider Identifier
1053844340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 060413
- Practice address
- 100 Genesee St
New Hartford, NY 13413 - Phone
- (315) 724-5437
- NPI assigned
- Apr 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 060413 | NY | Primary |
Addresses
Primary practice location
100 Genesee St
New Hartford, NY 13413
Mailing address
100 Genesee St
New Hartford, NY 13413-2328
Other practice location 1
114 Squire Hall
Buffalo, NY 14214-8006
Phone (716) 829-3717
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190129003279 | NY | Order and Referring Only - Dentist | 7214274216 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 060413 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562716800000",
"number": "1053844340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GENESEE ST",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "134132328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GENESEE ST",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "13413",
"telephone_number": "315-724-5437"
}
],
"practiceLocations": [
{
"address_1": "114 Squire Hall",
"address_purpose": "LOCATION",
"city": "Buffalo",
"state": "NY",
"postal_code": "142148006",
"country_code": "US",
"telephone_number": "716-829-3717",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MICARONI",
"first_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-04",
"last_updated": "2019-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "060413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Hartford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.