NPIMap

Organization Active NPI

Mt. Sinai Family Dental

  • Endodontics
  • Mount Sinai, NY
National Provider Identifier
1205047693
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
047118 Issued in NY
Legal business name
MT. SINAI FAMILY DENTAL
Practice address
5505 Nesconset Hwy
Ste. 230
Mount Sinai, NY 11766-2037
Phone
(631) 331-8989
Fax
(631) 331-7962
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Antoinette Derenzo
Title
Office Manager
Phone
(631) 331-8989

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 047118 NY Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 047078 NY
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 048342 NY

Addresses

Primary practice location

5505 Nesconset Hwy
Ste. 230
Mount Sinai, NY 11766-2037

Mailing address

5505 Nesconset Hwy
Ste. 230
Mount Sinai, NY 11766-2037
Phone (631) 331-8989

National Provider Directory

National Provider Directory

Locations

5505 Nesconset Hwy
Ste 230
Mount Sinai, NY 11766
Phone (631) 331-8989

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1205047693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 NESCONSET HWY",
            "address_2": "STE. 230",
            "city": "MOUNT SINAI",
            "state": "NY",
            "postal_code": "117662037",
            "telephone_number": "631-331-8989",
            "fax_number": "631-331-7962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 NESCONSET HWY",
            "address_2": "STE. 230",
            "city": "MOUNT SINAI",
            "state": "NY",
            "postal_code": "117662037",
            "telephone_number": "631-331-8989",
            "fax_number": "631-331-7962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. SINAI FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DERENZO",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-331-8989",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "047118",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047078",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "048342",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Sinai, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.