Individual provider Active NPI

Robert C Freiberg, DDS

  • Endodontics
  • Fairport, NY
National Provider Identifier
1336159367
Registry record updated Jan 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
050766 Issued in NY
Practice address
6800 Pittsford Palmyra Rd
Suite 110
Fairport, NY 14450-3584
Phone
(585) 223-5330
Fax
(585) 223-7601
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 050766 NY Primary

Addresses

Primary practice location

6800 Pittsford Palmyra Rd
Suite 110
Fairport, NY 14450-3584

Mailing address

6800 Pittsford Palmyra Rd
Suite 110
Fairport, NY 14450-3584
Phone (585) 223-5330

Other identifiers 1

IdentifierTypeStateIssuer
70586RFOtherNYBLUE SHIELD PROVIDER #

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
I20160705002197 NY Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 1951693365

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
050766NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester Endodontics Endodontics Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357084800000",
    "number": "1336159367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 PITTSFORD PALMYRA RD",
            "address_2": "SUITE 110",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503584",
            "telephone_number": "585-223-5330",
            "fax_number": "585-223-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 PITTSFORD PALMYRA RD",
            "address_2": "SUITE 110",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503584",
            "telephone_number": "585-223-5330",
            "fax_number": "585-223-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREIBERG",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "050766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "70586RF",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairport, NY

Sources for this page

Verify at the official NPI Registry.