Individual provider Active NPI

Ronit Etra, DMD

  • Pediatric Dentistry
  • Bronx, NY
National Provider Identifier
1285933390
Registry record updated Dec 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
056074 Issued in NY
Practice address
731 White Plains Rd
Bronx, NY 10473-2631
Phone
(718) 589-8775
NPI assigned
Mar 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 056074 NY Primary

Addresses

Primary practice location

731 White Plains Rd
Bronx, NY 10473-2631

Mailing address

58 E 83Rd St Apt 1B
New York, NY 10028-1125
Phone (917) 656-3974

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
I20190422001838 NY Practitioner - Dentist 6507108677 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
056074NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
The Institute for Family Health CurrentSince Mar 16, 2019 Accepting new patients
The Institute for Family Health Current Accepting new patients

Locations

731 White Plains Rd
Bronx, NY 10473
Phone (718) 589-8324

279 Main St
Ste 204
New Paltz, NY 12561
Phone (845) 255-3046

1824 Madison Ave
New York, NY 10035
Phone (212) 423-4200

Organizations & group practices 2

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": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513814400000",
    "number": "1285933390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 E 83RD ST APT 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100281125",
            "telephone_number": "917-656-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 WHITE PLAINS RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104732631",
            "telephone_number": "718-589-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETRA",
        "first_name": "RONIT",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2017-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.