Individual provider Active NPI

Luke C Soletic, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • New York, NY
National Provider Identifier
1164879581
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
062544 Issued in NY
Practice address
515 Madison Ave FL 28
New York, NY 10022-5421
Phone
(212) 813-0707
Fax
(212) 813-0808
NPI assigned
May 16, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 062544 NY Primary

Addresses

Primary practice location

515 Madison Ave FL 28
New York, NY 10022-5421

Mailing address

515 Madison Ave FL 28
New York, NY 10022-5421
Phone (212) 813-0707

Other practice location 1

132 N Park Ave Ste 2
Rockville Centre, NY 11570-4107
Phone (559) 251-6823

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220929000730 NY Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 0749571560 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
515Oms LLC Oral and Maxillofacial Surgery CurrentSince Sep 8, 2024 Accepting new patients
Long Island Oral & Maxillofacial Surgery, PC Oral and Maxillofacial Surgery CurrentSince Jul 1, 2022 Accepting new patients
Long Island Oral & Maxillofacial Surgery, PC Oral and Maxillofacial Surgery CurrentSince Jul 1, 2022 Accepting new patients

Locations

134 Mineola Blvd
Ste 302
Mineola, NY 11501
Phone (516) 294-9696

134 Mineola Blvd
Fl 3
Mineola, NY 11501
Phone (516) 294-9696

515 Madison Ave
Fl 28
New York, NY 10022
Phone (212) 765-5030

14 Vanderventer Ave
Ste 260
Prt Washingtn, NY 11050
Phone (516) 783-2042

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1164879581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 MADISON AVE FL 28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100225421",
            "telephone_number": "212-813-0707",
            "fax_number": "212-813-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MADISON AVE FL 28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100225421",
            "telephone_number": "212-813-0707",
            "fax_number": "212-813-0808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "132 N Park Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Rockville Centre",
            "state": "NY",
            "postal_code": "115704107",
            "country_code": "US",
            "telephone_number": "559-251-6823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOLETIC",
        "first_name": "LUKE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-16",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "062544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.