Individual provider Active NPI

Maria De Jesus Herrera, DDS

  • Dentist
  • Jackson Heights, NY
National Provider Identifier
1063498046
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
041976 Issued in NY
Practice address
3753 91St St
Jackson Heights, NY 11372-7901
Phone
(718) 205-4377
Fax
(718) 205-8605
NPI assigned
Dec 21, 2005
Last updated
Dec 14, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 041976 NY Primary

Addresses

Primary practice location

3753 91St St
Jackson Heights, NY 11372-7901

Mailing address

3753 91St St
Jackson Heights, NY 11372-7901
Phone (718) 205-4377

Other identifiers 1

IdentifierTypeStateIssuer
01161288MedicaidNY

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
I20150831000152 NY Order and Referring Only - DentistPractitioner - Dentist 4486960929

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Maria D. Herrera Dentistry, P.C. 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1063498046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3753 91ST ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727901",
            "telephone_number": "718-205-4377",
            "fax_number": "718-205-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3753 91ST ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727901",
            "telephone_number": "718-205-4377",
            "fax_number": "718-205-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRERA",
        "first_name": "MARIA",
        "middle_name": "DE JESUS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "041976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01161288",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.