Charles John Ptak Jr., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

034744 Issued in NY

Practice address

92 Norman Ave
Brooklyn, NY 11222-2934

Phone

(718) 383-5551

Fax

(718) 349-0930

NPI assigned

Jul 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Specialty Dental of Greenpoint, P.C.

  • Pediatric Dentistry
  • Brooklyn, NY
  • NPI 1750434809

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083629778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 NORMAN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112222934",
            "telephone_number": "718-383-5551",
            "fax_number": "718-349-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 NORMAN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112222934",
            "telephone_number": "718-383-5551",
            "fax_number": "718-349-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PTAK",
        "first_name": "CHARLES",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "034744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00782729",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Psychotherapy and Mental Wellness Group Practice, PLLC
• Psychotherapy and Quality Assurance Services
• Psychotherapy Practice
• PT and OT for Senior Rehab at Home PLLC
• Pta on the Road PLLC
• Ptbydeb,LLC
• PTS of Brooklyn Lthhcp
• PTS of Westchester, Inc. (PTS of Manhattan LTHHCP)
• Qinghua Pu
• Public Health Solutions (Public Health Solutions -SRHC)

• Oral and Maxillofacial Surgery (Dentist) in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.