Active NPI
Ryan William Rengifo, DDS
- General Practice Dentistry
- Norwalk, CT
National Provider Identifier
1114404373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12323
- Practice address
- 360 Connecticut Ave
Norwalk, CT 06854-1824 - Phone
- (203) 831-0080
- NPI assigned
- Jul 20, 2018
- 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 | 12323 | CT | Primary |
Addresses
Primary practice location
360 Connecticut Ave
Norwalk, CT 06854-1824
Mailing address
20910 41St Ave Apt 6a
Bayside, NY 11361-1908
Phone (917) 607-1281
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12323 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532044800000",
"number": "1114404373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20910 41ST AVE APT 6A",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113611908",
"telephone_number": "917-607-1281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 CONNECTICUT AVE",
"city": "NORWALK",
"state": "CT",
"postal_code": "068541824",
"telephone_number": "203-831-0080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENGIFO",
"first_name": "RYAN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-20",
"last_updated": "2018-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "12323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwalk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.