Individual provider Active NPI

Theodore Sewitch, D.M.D. M.S.

  • Dentist
  • New York, NY
National Provider Identifier
1104105907
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
38444 Issued in NY
Practice address
60 East 56TH Street
5TH Floor
New York, NY 10022
Phone
(212) 753-7672
Fax
(212) 758-6822
NPI assigned
Aug 10, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 38444 NY Primary

Addresses

Primary practice location

60 East 56TH Street
5TH Floor
New York, NY 10022

Mailing address

60 East 56TH Street
5TH Floor
New York, NY 10022
Phone (212) 753-7672

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160429001432 NY Order and Referring Only - DentistPractitioner - Dentist 8426357161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
38444NYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1104105907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 EAST 56TH STREET",
            "address_2": "5TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10022",
            "telephone_number": "212-753-7672",
            "fax_number": "212-758-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 EAST 56TH STREET",
            "address_2": "5TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10022",
            "telephone_number": "212-753-7672",
            "fax_number": "212-758-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEWITCH",
        "first_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "D.M.D. M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "38444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.