Active NPI
Manjiri Pande, DMD
- General Practice Dentistry
- Brentwood, NY
National Provider Identifier
1104077643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 052798-1
- Practice address
- 566 Suffolk Ave
Brentwood, NY 11717-4210 - Phone
- (631) 231-5566
- NPI assigned
- Oct 2, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 052798-1 | NY | Primary |
Addresses
Primary practice location
566 Suffolk Ave
Brentwood, NY 11717-4210
Mailing address
207 Loring Rd
Levittown, NY 11756-1057
Phone (516) 749-5511
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 |
|---|---|---|---|---|
| I20150818005571 | NY | Order and Referring Only - Dentist | 4486969532 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052798-1 | NY | MD | General Practice Dentistry |
| 052798 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222905600000",
"number": "1104077643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 LORING RD",
"city": "LEVITTOWN",
"state": "NY",
"postal_code": "117561057",
"telephone_number": "516-749-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "566 SUFFOLK AVE",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117174210",
"telephone_number": "631-231-5566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANDE",
"first_name": "MANJIRI",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-02",
"last_updated": "2008-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "052798-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.