Active NPI
Dennis Lyle Draizin, MD
- Otolaryngology Physician
- Rockville Centre, NY
National Provider Identifier
1083632905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 134130
- Practice address
- 195 N Village Ave
Suite 1
Rockville Centre, NY 11570-3814 - Phone
- (516) 536-7777
- Fax
- (516) 536-9225
- NPI assigned
- Jul 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 134130 | NY | Primary |
Addresses
Primary practice location
195 N Village Ave
Suite 1
Rockville Centre, NY 11570-3814
Mailing address
195 N Village Ave
Suite 1
Rockville Centre, NY 11570-3814
Phone (516) 536-7777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00774956 | Medicaid | NY |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090424000186 | NY | Practitioner - Otolaryngology | 7719035013 | Practice locations: Carle Place, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 134130 | NY | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083632905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "195 N VILLAGE AVE",
"address_2": "SUITE 1",
"city": "ROCKVILLE CENTRE",
"state": "NY",
"postal_code": "115703814",
"telephone_number": "516-536-7777",
"fax_number": "516-536-9225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "195 N VILLAGE AVE",
"address_2": "SUITE 1",
"city": "ROCKVILLE CENTRE",
"state": "NY",
"postal_code": "115703814",
"telephone_number": "516-536-7777",
"fax_number": "516-536-9225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAIZIN",
"first_name": "DENNIS",
"middle_name": "LYLE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NY",
"license": "134130",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00774956",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockville Centre, NY
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- Joalba Drabner
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- Drucker Genuth Augenstein & Kasow, MDS PC (South Shore Radiology)
- Jeffrey P. Drucker, M.D.
- Shaina Drucker, DPT
- Pamela R Drullinsky, MD
Sources for this page
- 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.