Individual provider Active NPI

Pearl Rose Sussman, D.M.D,

  • General Practice Dentistry
  • Bronx, NY
National Provider Identifier
1184766834
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0411421 Issued in NY
Practice address
5683 Riverdale Ave
Suite 205
Bronx, NY 10471-2127
Phone
(718) 884-8808
Fax
(718) 884-8818
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0411421 NY Primary

Addresses

Primary practice location

5683 Riverdale Ave
Suite 205
Bronx, NY 10471-2127

Mailing address

5683A Riverdale Ave.
Suite 205
Riverdale, NY 10471
Phone (718) 884-8808

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

State licenses

LicenseStateTypeSpecialty
0411421NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184766834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5683A RIVERDALE AVE.",
            "address_2": "SUITE 205",
            "city": "RIVERDALE",
            "state": "NY",
            "postal_code": "10471",
            "telephone_number": "718-884-8808",
            "fax_number": "718-884-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5683 RIVERDALE AVE",
            "address_2": "SUITE 205",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104712127",
            "telephone_number": "718-884-8808",
            "fax_number": "718-884-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSSMAN",
        "first_name": "PEARL",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "D.M.D,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0411421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.