Individual provider Active NPI

Nicholas John Nicastro, D.D.S.

  • General Practice Dentistry
  • Port Jefferson Station, NY
National Provider Identifier
1265606016
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
028249 Issued in NY
Practice address
5225 Route 347
Suite 52
Port Jefferson Station, NY 11776-2053
Phone
(631) 928-2020
Fax
(631) 928-2417
NPI assigned
Apr 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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 028249 NY Primary

Addresses

Primary practice location

5225 Route 347
Suite 52
Port Jefferson Station, NY 11776-2053

Mailing address

5225 Route 347
Suite 52
Port Jefferson Station, NY 11776-2053
Phone (631) 928-2020

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

LicenseStateTypeSpecialty
028249NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
NJ Nicastro Dental PC General Practice Past 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": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1265606016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 ROUTE 347",
            "address_2": "SUITE 52",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762053",
            "telephone_number": "631-928-2020",
            "fax_number": "631-928-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 ROUTE 347",
            "address_2": "SUITE 52",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762053",
            "telephone_number": "631-928-2020",
            "fax_number": "631-928-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICASTRO",
        "first_name": "NICHOLAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "028249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.