Active NPI
Pierre Khanschassoff, DDS
- General Practice Dentistry
- Stony Brook, NY
National Provider Identifier
1083706832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 41825
- Practice address
- 111 Manchester LN
Stony Brook, NY 11790-2847 - Phone
- (631) 689-8570
- Fax
- (631) 689-8583
- NPI assigned
- Sep 29, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 41825 | NY | Primary |
Addresses
Primary practice location
111 Manchester LN
Stony Brook, NY 11790-2847
Mailing address
111 Manchester LN
Stony Brook, NY 11790-2847
Phone (631) 689-8570
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 |
|---|---|---|---|---|
| I20160311002157 | NY | Order and Referring Only - Dentist | 2062718331 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41825 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083706832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 MANCHESTER LN",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117902847",
"telephone_number": "631-689-8570",
"fax_number": "631-689-8583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 MANCHESTER LN",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117902847",
"telephone_number": "631-689-8570",
"fax_number": "631-689-8583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANSCHASSOFF",
"first_name": "PIERRE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "41825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
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.