Theresa C Fan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0519371 Issued in NY

Practice address

400 Community Dr
Manhasset, NY 11030-3815

Phone

(516) 562-4525

NPI assigned

Oct 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Dentist

Education

Columbia University College of Dental Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Black Hall Dental PCGroup PAC ID 6901283308, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989

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.

• Black Hall Dental, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Manhasset, NY
  • NPI 1356091516
  Medicare reassignment Care Compare group NPD
• White Hall Dental, PC

  • Dentist
  • New Hyde Park, NY
  • NPI 1376268821
  Medicare reassignment NPD
• Black Hall Dental, P.C.

  • Dentist
  • New Hyde Park, NY
  • NPI 1336991876
  NPD Authorized official

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306921820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 SICARDI CT",
            "city": "CARLE PLACE",
            "state": "NY",
            "postal_code": "115141704",
            "telephone_number": "516-997-7461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303815",
            "telephone_number": "516-562-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "THERESA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0519371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carina Falco, CPNP
• John Fallon, MD
• Tracy Falodun
• Nicole Ashley Famiglietti, PA-C
• Family Orthopaedic & Sports Physical Therapy, PLLC
• Temiloluwa Fiyinfoluwa Faokunla
• Bruce Farber, MD
• Melissa Lyn Farina, PT, MS
• Peter Farmer, MD
• Zeba Faroqui

• General Practice Dentistry in Manhasset, NY
• Providers in Manhasset, 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 Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.