Active NPI
Nathaniel Gomolin, DMD
- Dentist
- Plattsburgh, NY
National Provider Identifier
1124867916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 065524
- Practice address
- 37 Boynton Ave Ste 2
Plattsburgh, NY 12901-1268 - Phone
- (518) 563-5002
- Fax
- (518) 205-7795
- NPI assigned
- May 21, 2024
- Reactivated
- Feb 10, 2025
- 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 | 065524 | NY | Primary |
Addresses
Primary practice location
37 Boynton Ave Ste 2
Plattsburgh, NY 12901-1268
Mailing address
200 East 82ND St
23J
New York, NY 10028
Phone (514) 581-1297
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1124867916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 EAST 82ND ST",
"address_2": "23J",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10028",
"telephone_number": "514-581-1297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 BOYNTON AVE STE 2",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129011268",
"telephone_number": "518-563-5002",
"fax_number": "518-205-7795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMOLIN",
"first_name": "NATHANIEL",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-21",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"deactivation_date": "2025-01-14",
"reactivation_date": "2025-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "065524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.