Individual provider Active NPI

Marina Pinkhasova, DDS

  • Dentist
  • Rego Park, NY
National Provider Identifier
1205042033
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0458341 Issued in NY
Practice address
98-120 Queens Blvd
Suite 1LM
Rego Park, NY 11374
Phone
(718) 897-3434
Fax
(718) 997-0342
NPI assigned
May 16, 2007
Sex
Female
Sole proprietor
No

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
Dentist 122300000X 0458341 NY Primary

Addresses

Primary practice location

98-120 Queens Blvd
Suite 1LM
Rego Park, NY 11374

Mailing address

98-120 Queens Blvd
Suite 1LM
Rego Park, NY 11374
Phone (718) 897-3434

Other identifiers 1

IdentifierTypeStateIssuer
01597575MedicaidNY

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160927000374 NY Order and Referring Only - DentistPractitioner - Dentist 7214224740

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0458341NYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Robert Malakov Physician, P.C Past Accepting new patients
Affordable Dental Care PC Dentist PastSince Jan 12, 1998 Accepting new patients

Organizations & group practices 2

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": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205042033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-120 QUEENS BLVD",
            "address_2": "SUITE 1LM",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374",
            "telephone_number": "718-897-3434",
            "fax_number": "718-997-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-120 QUEENS BLVD",
            "address_2": "SUITE 1LM",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374",
            "telephone_number": "718-897-3434",
            "fax_number": "718-997-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINKHASOVA",
        "first_name": "MARINA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0458341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01597575",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.