Individual provider Active NPI

Robert Stephen Gureasko, DDS

  • Endodontics
  • New York, NY
National Provider Identifier
1134337389
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
031806 Issued in NY
Practice address
1824 Madison Ave
New York, NY 10035-3832
Phone
(212) 423-4400
NPI assigned
May 20, 2007
Last updated
Mar 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 031806 NY Primary

Addresses

Primary practice location

1824 Madison Ave
New York, NY 10035-3832

Mailing address

36 Old Pond Rd
South Salem, NY 10590-1018
Phone (973) 714-7582

Other practice location 1

36 Old Pond Rd
South Salem, NY 10590-1018
Phone (973) 714-7582

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190328002889 NY Practitioner - Dentist 3476893413 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Institute for Family Health Current Accepting new patients
The Institute for Family Health CurrentSince Mar 20, 2019 Accepting new patients

Locations

279 Main St
Ste 204
New Paltz, NY 12561
Phone (845) 255-3046

1824 Madison Ave
New York, NY 10035
Phone (212) 423-4200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1134337389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 OLD POND RD",
            "city": "SOUTH SALEM",
            "state": "NY",
            "postal_code": "105901018",
            "telephone_number": "973-714-7582",
            "fax_number": "914-763-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100353832",
            "telephone_number": "212-423-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36 Old Pond Rd",
            "address_purpose": "LOCATION",
            "city": "South Salem",
            "state": "NY",
            "postal_code": "105901018",
            "country_code": "US",
            "telephone_number": "973-714-7582",
            "fax_number": "914-763-8225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUREASKO",
        "first_name": "ROBERT",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-20",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "031806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.