Individual provider Active NPI

Michael Ian Israel, D.M.D

  • General Practice Dentistry
  • Hawthorne, NY
National Provider Identifier
1326549189
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
060823 Issued in NY
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

Updated by the provider on Apr 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190104000535 NY Order and Referring Only - DentistPractitioner - Dentist 3870839319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI02771200NJMDGeneral Practice Dentistry
060823NYMDGeneral 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

Verify at the official NPI Registry.