Active NPI
Michael Neal Ettinger, DDS
- Dentist
- Brooklyn, NY
National Provider Identifier
1093796641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 033673
- Practice address
- 3020 Avenue Y
Apartment 10
Brooklyn, NY 11235-1452 - Phone
- (718) 332-1188
- NPI assigned
- Nov 10, 2005
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 033673 | NY | Primary |
Addresses
Primary practice location
3020 Avenue Y
Apartment 10
Brooklyn, NY 11235-1452
Mailing address
3020 Avenue Y
Apartment 1D
Brooklyn, NY 11235-1452
Phone (718) 332-1188
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 |
|---|---|---|---|---|
| I20150714002179 | NY | Order and Referring Only - Dentist | 8022321439 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033673 | NY | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1093796641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 AVENUE Y",
"address_2": "APARTMENT 1D",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112351452",
"telephone_number": "718-332-1188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 AVENUE Y",
"address_2": "APARTMENT 10",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112351452",
"telephone_number": "718-332-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTINGER",
"first_name": "MICHAEL",
"middle_name": "NEAL",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "033673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; 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.