Individual provider Active NPI

Besa Marisenoj, DMD

  • General Practice Dentistry
  • Staten Island, NY
National Provider Identifier
1316184500
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
054054 Issued in NY
Practice address
621 Katan Ave
Staten Island, NY 10312-3422
Phone
(718) 948-4000
NPI assigned
Jan 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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 054054 NY Primary

Addresses

Primary practice location

621 Katan Ave
Staten Island, NY 10312-3422

Mailing address

621 Katan Ave
Staten Island, NY 10312-3422
Phone (718) 948-4000

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
I20160115000487 NY Order and Referring Only - DentistPractitioner - Dentist 9830492412

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Staten Island Smile Dental PLLC General Practice PastSince Oct 19, 2020 Accepting new patients
Ira Camhi, D.D.S., P.C. PastSince Oct 19, 2020 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1316184500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 KATAN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123422",
            "telephone_number": "718-948-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 KATAN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123422",
            "telephone_number": "718-948-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARISENOJ",
        "first_name": "BESA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-09",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "054054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.