Individual provider Active NPI

Reginald G Moncrieff, DDS

  • General Practice Dentistry
  • Ny, NY
National Provider Identifier
1326104639
Registry record updated Jul 8, 2007
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
034452 Issued in NY
Practice address
115 Central Park West
Ny, NY 10023
Phone
(712) 580-4520
NPI assigned
Dec 29, 2006
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 034452 NY Primary

Addresses

Primary practice location

115 Central Park West
Ny, NY 10023

Mailing address

115 Central Park West
Ny, NY 10023
Phone (712) 580-4520

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
I20160825001257 NY Order and Referring Only - DentistPractitioner - Dentist 6305131681

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
034452NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326104639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 CENTRAL PARK WEST",
            "city": "NY",
            "state": "NY",
            "postal_code": "10023",
            "telephone_number": "712-580-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CENTRAL PARK WEST",
            "city": "NY",
            "state": "NY",
            "postal_code": "10023",
            "telephone_number": "712-580-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCRIEFF",
        "first_name": "REGINALD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "034452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ny, NY

Sources for this page

Verify at the official NPI Registry.