Thomas Degenero I
Individual provider Active NPI Dentist · West Sand Lake, NY
NPI 1346671872 · NPPES record last updated Dec 10, 2013
Key facts
- NPI
- 1346671872
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 37900 (NY)
- Practice address
- 4482 Ny Route 150
West Sand Lake, NY 12018 - Phone
- (518) 674-8500
- Fax
- (518) 674-8885
- NPI assigned
- Dec 10, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161103000883 | NY | Order and Referring Only - Dentist |
0143508689 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37900 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas J. Degenero D.D.S. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 37900 | NY | Yes |
Addresses
Primary practice location
4482 Ny Route 150
West Sand Lake, NY 12018
Mailing address
PO Box 367
West Sand Lake, NY 12196-0367
Phone (518) 674-8500
Other providers in West Sand Lake, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.