Active NPI
Kevin Mark Fahey, DMD
- Endodontics
- Syracuse, NY
National Provider Identifier
1124210919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- NY050049
- Practice address
- 600 East Genesee St
Syracuse, NY 13202 - Phone
- (315) 476-7406
- Fax
- (315) 476-7408
- NPI assigned
- Aug 15, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | NY050049 | NY | Primary |
| Endodontics | 1223E0200X | DN15647 | FL |
Addresses
Primary practice location
600 East Genesee St
Syracuse, NY 13202
Mailing address
600 East Genesee St
Syracuse, NY 13202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 9, 2015 through Dec 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN15647 | FL | MD | Endodontist |
| NY050049 | NY | MD | Endodontist |
| 050049 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187136000000",
"number": "1124210919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 EAST GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 EAST GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202",
"telephone_number": "315-476-7406",
"fax_number": "315-476-7408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHEY",
"first_name": "KEVIN",
"middle_name": "MARK",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-15",
"last_updated": "2007-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "NY050049",
"primary": true
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN15647",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.