Ivan Pak, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

062441 Issued in NY

Practice address

520 Franklin Ave Ste 112
Garden City, NY 11530-5814

Phone

(516) 746-3636

NPI assigned

Feb 18, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: ipak@montefioredirect.com

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

{
    "created_epoch": "1518912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1134629900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27005 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 FRANKLIN AVE STE 112",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115305814",
            "telephone_number": "516-746-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "IVAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-18",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "062441",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Anthony Pace, PH.D.
• Sybil Padavathil, DMD
• Diane Padernacht, LMSW
• Lizbeth Pagan, MS, RD, CDN, CDE
• Pain Medicine PC
• Jae Hyeong Pak, DDS
• Susan M Palleschi, MD
• Marco Palmieri, DO
• Petros Panagos, DDS
• Robert Panariello, PT

• Endodontics in Garden City, NY
• Providers in Garden City, NY by specialty
• Endodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.