Individual provider Active NPI

Andrew Charles Palermo, DDS

  • General Practice Dentistry
  • East Northport, NY
National Provider Identifier
1225144769
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
045141-1 Issued in NY
Practice address
2 Romany Way
East Northport, NY 11731-5118
Phone
(631) 368-2882
Fax
(631) 368-0864
NPI assigned
Aug 21, 2006
Sex
Male
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
General Practice Dentistry 1223G0001X 045141-1 NY Primary

Addresses

Primary practice location

2 Romany Way
East Northport, NY 11731-5118

Mailing address

2 Romany Way
East Northport, NY 11731-5118
Phone (631) 368-2882

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
I20160509001763 NY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2163721432

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
045141NYMDSocial Worker
045141-1NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Andrew C Palermo DDS PC PastSince Jan 6, 2017 Accepting new patients

Organizations & group practices 1

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225144769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 ROMANY WAY",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117315118",
            "telephone_number": "631-368-2882",
            "fax_number": "631-368-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 ROMANY WAY",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117315118",
            "telephone_number": "631-368-2882",
            "fax_number": "631-368-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALERMO",
        "first_name": "ANDREW",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045141-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Northport, NY

Sources for this page

Verify at the official NPI Registry.