Edward C Brant, DDS
Individual provider Active NPI Periodontics · St James, NY
NPI 1154586733 · NPPES record last updated Jul 23, 2008
Key facts
- NPI
- 1154586733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 043007 (NY)
- Practice address
- 447 Lake Avenue
St James, NY 11780 - Phone
- (631) 584-4395
- Fax
- (631) 584-4398
- NPI assigned
- Jul 23, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160516000748 | NY | Order and Referring Only - Dentist |
8426347469 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043007 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 043007 | NY | Yes |
Addresses
Primary practice location
447 Lake Avenue
St James, NY 11780
Mailing address
447 Lake Avenue
St James, NY 11780
Phone (631) 584-4395
Other providers in St James, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.