Active NPI
Mona Boside, DDS
- Endodontics
- New York, NY
National Provider Identifier
1245757608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 059419
- Practice address
- 630 W 168TH St PH 7
New York, NY 10032-3725 - Phone
- (212) 305-7069
- NPI assigned
- Aug 26, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 059419 | NY | Primary |
Addresses
Primary practice location
630 W 168TH St PH 7
New York, NY 10032-3725
Mailing address
12 Grandview Ave
Stamford, CT 06905-4803
Phone (203) 278-4740
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 |
|---|---|---|---|
| 059419 | NY | MD | Endodontist |
Interoperability endpoints
- mob7009@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503705600000",
"number": "1245757608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 GRANDVIEW AVE",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069054803",
"telephone_number": "203-278-4740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 W 168TH ST PH 7",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725",
"telephone_number": "212-305-7069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSIDE",
"first_name": "MONA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-26",
"last_updated": "2017-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "059419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.