Black Hall Dental, P.C.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BLACK HALL DENTAL, P.C.

Practice address

10 Medical PLZ Ste 210
Glen Cove, NY 11542-2101

Phone

(516) 671-2903

NPI assigned

Apr 5, 2024

Organization subpart

Yes

Parent organization

BLACK HALL DENTAL, P.C.As reported in NPPES

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

Authorized official

Name

Theresa Fan, DDS

Title

Administrator

Phone

(516) 674-7646

Specialties & licenses 1

Addresses

Other names 1

• 10 Medical Plaza DME Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Black Hall Dental, P.C.

  • Dentist
  • New Hyde Park, NY
  • NPI 1336991876

  6901283308

  Same PAC ID
• Black Hall Dental, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Manhasset, NY
  • NPI 1356091516

  6901283308

  Same PAC ID

Tax ID family

Black Hall Dental PC3 organizations share this tax ID, including this one

Part of

Black Hall Dental PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Black Hall Dental, P.C.

  • Dentist
  • New Hyde Park, NY
  • NPI 1336991876
  NPD tax ID
• Black Hall Dental, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Manhasset, NY
  • NPI 1356091516
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Black Hall Dental, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Manhasset, NY
  • NPI 1356091516
  NPPES parent name

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

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1306698840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PLZ STE 210",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422101",
            "telephone_number": "516-671-2903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PLZ STE 210",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422101",
            "telephone_number": "516-671-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HALL DENTAL, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK HALL DENTAL, P.C.",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "516-674-7646",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "10 Medical Plaza DME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Holly Berns, MD
• BH DME Inc
• Mahbub Mohammad Bhuiyan, MD
• Roshni Bisoondial, MD
• Suzanne Paige Blacharski, LCSW
• Rachel Blihar, RD
• Amanda Bodner
• Scott Bodner
• Bodyset Physical & Occupational Therapy PLLC
• Bodyset Physical Therapy PLLC

• Dentist in Glen Cove, NY
• Providers in Glen Cove, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.