Active NPI
Michael Ian Israel, D.M.D
- General Practice Dentistry
- Hawthorne, NY
National Provider Identifier
1326549189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 060823
- Practice address
- 19 Skyline Dr
Hawthorne, NY 10532-2134 - Phone
- (914) 594-2700
- NPI assigned
- Feb 26, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI02771200 | NJ | |
| General Practice Dentistry | 1223G0001X | 060823 | NY | Primary |
Addresses
Primary practice location
19 Skyline Dr
Hawthorne, NY 10532-2134
Mailing address
588 Eagle Rock Ave Ste 1
West Orange, NJ 07052-3620
Phone (973) 674-1414
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190104000535 | NY | Order and Referring Only - Dentist | 3870839319 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02771200 | NJ | MD | General Practice Dentistry |
| 060823 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1326549189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "588 EAGLE ROCK AVE STE 1",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070523620",
"telephone_number": "973-674-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 SKYLINE DR",
"city": "HAWTHORNE",
"state": "NY",
"postal_code": "105322134",
"telephone_number": "914-594-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISRAEL",
"first_name": "MICHAEL",
"middle_name": "IAN",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-26",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02771200",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "060823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hawthorne, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.