Active NPI
Joshua Michael Chubak, D.D.S.
- Endodontics
- New York, NY
National Provider Identifier
1114272192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 056087
- Practice address
- 200 W 57TH St Ste 808
New York, NY 10019-3211 - Phone
- (212) 737-6112
- Fax
- (646) 797-3999
- NPI assigned
- Jul 17, 2012
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 056087 | NY | Primary |
Addresses
Primary practice location
200 W 57TH St Ste 808
New York, NY 10019-3211
Mailing address
77 Washington Ave
Lawrence, NY 11559-1803
Phone (516) 374-1745
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 |
|---|---|---|---|---|
| I20150925000963 | NY | Order and Referring Only - Oral Surgery | 9335457225 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056087 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacobson and Chubak Endodontics PLLC | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- New York, NY
- NPI 1396140679
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1114272192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 WASHINGTON AVE",
"city": "LAWRENCE",
"state": "NY",
"postal_code": "115591803",
"telephone_number": "516-374-1745",
"fax_number": "516-374-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W 57TH ST STE 808",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100193211",
"telephone_number": "212-737-6112",
"fax_number": "646-797-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUBAK",
"first_name": "JOSHUA",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-17",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "056087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.