Active NPI
Susan Medina, RDH
- Dental Hygienist
- Owego, NY
National Provider Identifier
1306388244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 022904
- Practice address
- 1062 State RT 38
Suite 120
Owego, NY 13827 - Phone
- (607) 687-8595
- NPI assigned
- Nov 9, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 022904 | NY | Primary |
Addresses
Primary practice location
1062 State RT 38
Suite 120
Owego, NY 13827
Mailing address
PO Box 120
1062 State RT 38
Owego, NY 13827
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 |
|---|---|---|---|
| 022904 | NY | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478649600000",
"number": "1306388244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 120",
"address_2": "1062 STATE RT 38",
"city": "OWEGO",
"state": "NY",
"postal_code": "13827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1062 STATE RT 38",
"address_2": "SUITE 120",
"city": "OWEGO",
"state": "NY",
"postal_code": "13827",
"telephone_number": "607-687-8595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "SUSAN",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-09",
"last_updated": "2016-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "NY",
"license": "022904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.