Active NPI
Alan E Roitman, DDS
- Dentist
- Port Jefferson Station, NY
National Provider Identifier
1124136312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 030242
- Practice address
- 3 Roosevelt Ave
Port Jefferson Station, NY 11776 - Phone
- (631) 928-7200
- Fax
- (631) 474-4613
- NPI assigned
- Aug 28, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 030242 | NY | Primary |
Addresses
Primary practice location
3 Roosevelt Ave
Port Jefferson Station, NY 11776
Mailing address
3 Roosevelt Ave
Port Jefferson Station, NY 11776
Phone (631) 928-7200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00637701 | Medicaid | NY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030242 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124136312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 ROOSEVELT AVE",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "11776",
"telephone_number": "631-928-7200",
"fax_number": "631-474-4613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 ROOSEVELT AVE",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "11776",
"telephone_number": "631-928-7200",
"fax_number": "631-474-4613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROITMAN",
"first_name": "ALAN",
"middle_name": "E",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "030242",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00637701",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.