Eldridge Dental Care P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047879 Issued in NY

Legal business name

ELDRIDGE DENTAL CARE P.C.

Practice address

1432 Forest Ave
Staten Island, NY 10302-2204

Phone

(718) 442-9254

Fax

(718) 720-9107

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dmitriy Volotsenko, DDS

Title

Ceo

Phone

(718) 442-9254

Specialties & licenses 4

Addresses

Other identifiers 1

Tax ID family

Eldridge Dental Care PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eldridge Dental Care, P.C.

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1164576575
  NPD tax ID

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194862953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1432 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022204",
            "telephone_number": "718-442-9254",
            "fax_number": "718-720-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022204",
            "telephone_number": "718-442-9254",
            "fax_number": "718-720-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDRIDGE DENTAL CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VOLOTSENKO",
        "authorized_official_first_name": "DMITRIY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-442-9254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047879",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0419971",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "050410",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051388",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01954503",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abdelrahman Mahmoud Eldeeb, PTA
• Colette Pauline Elder
• Jomol Eldho, RN
• Rana M Eldorr, M.S. SLP
• Waleed Eldorr
• Eldridge Dental Care, P.C.
• Azza Elemam, MD
• Elena Sanders, MD, P.C.
• Zakariya Eleraire
• Husam Elessawy, PT,DPT

• All providers in Staten Island, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.