Individual provider Active NPI

Craig Rosenbaum, DDS

  • General Practice Dentistry
  • Jackson Heights, NY
National Provider Identifier
1063401560
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043046 Issued in NY
Practice address
3304 91St St
Suite #1W
Jackson Heights, NY 11372-1752
Phone
(718) 899-4455
Fax
(718) 899-4455
NPI assigned
Oct 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 043046 NY Primary

Addresses

Primary practice location

3304 91St St
Suite #1W
Jackson Heights, NY 11372-1752

Mailing address

3304 91St St
Suite #1W
Jackson Heights, NY 11372-1752
Phone (718) 899-4455

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
I20150713001549 NY Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 6103139696

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
043046NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Theodosiou & Rosenbaum General Dentistry General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1063401560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 91ST ST",
            "address_2": "SUITE #1W",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113721752",
            "telephone_number": "718-899-4455",
            "fax_number": "718-899-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3304 91ST ST",
            "address_2": "SUITE #1W",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113721752",
            "telephone_number": "718-899-4455",
            "fax_number": "718-899-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBAUM",
        "first_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.