Askold Roman Wynnykiw, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

041258 Issued in NY

Practice address

351 Osborne Rd
Loudonville, NY 12211-1660

Phone

(518) 432-3991

Fax

(518) 432-3987

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1275513848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 OSBORNE RD",
            "city": "LOUDONVILLE",
            "state": "NY",
            "postal_code": "122111660",
            "telephone_number": "518-432-3991",
            "fax_number": "518-432-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 OSBORNE RD",
            "city": "LOUDONVILLE",
            "state": "NY",
            "postal_code": "122111660",
            "telephone_number": "518-432-3991",
            "fax_number": "518-432-3987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNYKIW",
        "first_name": "ASKOLD",
        "middle_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "141817590",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Joseph Surin, RPH
• Judith C Tate, PHD
• McKenzie Venetz, RN
• Walgreen Co (Walgreens #19884)
• Lynn M Washock, COTA
• Michael Anthony Zappone, PHARM.D.

• General Practice Dentistry in Loudonville, NY
• Providers in Loudonville, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.