Individual provider Active NPI

Richard G Rosenblatt, DDS

  • General Practice Dentistry
  • Eastport, NY
National Provider Identifier
1306060769
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
037866 Issued in NY
Practice address
63 Eastport Manor Rd
Eastport, NY 11941-1411
Phone
(631) 325-3535
Fax
(631) 325-8750
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 037866 NY Primary

Addresses

Primary practice location

63 Eastport Manor Rd
Eastport, NY 11941-1411

Mailing address

63 Eastport Manor Rd
Eastport, NY 11941-1411
Phone (631) 325-3535

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
I20160203000514 NY Order and Referring Only - DentistPractitioner - Dentist 9335443803

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
037866NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306060769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 EASTPORT MANOR RD",
            "city": "EASTPORT",
            "state": "NY",
            "postal_code": "119411411",
            "telephone_number": "631-325-3535",
            "fax_number": "631-325-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 EASTPORT MANOR RD",
            "city": "EASTPORT",
            "state": "NY",
            "postal_code": "119411411",
            "telephone_number": "631-325-3535",
            "fax_number": "631-325-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBLATT",
        "first_name": "RICHARD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "037866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastport, NY

Sources for this page

Verify at the official NPI Registry.