NPIMap

Organization Active NPI

Black Hall Dental, P.C.

  • Dentist
  • New Hyde Park, NY
National Provider Identifier
1336991876
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BLACK HALL DENTAL, P.C.
Practice address
1999 Marcus Ave Ste M1
New Hyde Park, NY 11042-1023
Phone
(516) 441-5131
NPI assigned
Apr 5, 2024
Organization subpart
Yes
Parent organization
BLACK HALL DENTAL, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Theresa Fan, DDSNPI 1306921820
Title
Administrator
Phone
(516) 441-5131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1999 Marcus Ave Ste M1
New Hyde Park, NY 11042-1023

Mailing address

1999 Marcus Ave Ste M1
New Hyde Park, NY 11042-1023
Phone (516) 441-5131

Other names 1

  • 1999 Marcus Ave DME Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250404000011 NY DME Supplier - Oral Surgery - Dentist 6901283308 Practice locations: New Hyde Park, NY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Black Hall Dental PC3 organizations share this tax ID, including this one
Part of
Black Hall Dental PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1336991876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE STE M1",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421023",
            "telephone_number": "516-441-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE STE M1",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421023",
            "telephone_number": "516-441-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HALL DENTAL, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK HALL DENTAL, P.C.",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "516-441-5131",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1999 Marcus Ave DME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Hyde Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.