Active NPI
Elizabeth Sophie Persico, DMD
- Pediatric Dentistry
- New York, NY
National Provider Identifier
1225262488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 055145
- Practice address
- 15 E 91St St
New York, NY 10128-0648 - Phone
- (212) 966-6680
- NPI assigned
- May 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 055145 | NY | |
| Pediatric Dentistry | 1223P0221X | 055145 | NY | Primary |
Addresses
Primary practice location
15 E 91St St
New York, NY 10128-0648
Mailing address
78 Laight St
New York, NY 10013-2016
Phone (212) 966-6680
Other practice location 1
78 Laight St
New York, NY 10013-2016
Phone (212) 966-6680
Other practice location 2
130 Jessup Ave
Quogue, NY 11959-4244
Phone (212) 876-6475
Other names 1
- Elizabeth Sophie Jamiolkowski
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
| License | State | Type | Specialty |
|---|---|---|---|
| 055145 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1225262488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 LAIGHT ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100132016",
"telephone_number": "212-966-6680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 E 91ST ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101280648",
"telephone_number": "212-966-6680"
}
],
"practiceLocations": [
{
"address_1": "78 Laight St",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100132016",
"country_code": "US",
"telephone_number": "212-966-6680",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 Jessup Ave",
"address_purpose": "LOCATION",
"city": "Quogue",
"state": "NY",
"postal_code": "119594244",
"country_code": "US",
"telephone_number": "212-876-6475",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PERSICO",
"first_name": "ELIZABETH",
"middle_name": "SOPHIE",
"name_prefix": "Miss",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-03",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055145",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "055145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "JAMIOLKOWSKI",
"middle_name": "SOPHIE",
"credential": "DMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.