Active NPI
Ariel Bales-Kogan, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Elmhurst, NY
National Provider Identifier
1366639007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 055373
- Practice address
- 79-11 41St Ave
Unit A107
Elmhurst, NY 11373 - Phone
- (718) 205-2888
- Fax
- (718) 205-2855
- NPI assigned
- Sep 26, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 055373 | NY | Primary |
Addresses
Primary practice location
79-11 41St Ave
Unit A107
Elmhurst, NY 11373
Mailing address
305 W 150TH St
Apt 701
New York, NY 10039-2225
Phone (617) 319-4180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055373 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Interoperability endpoints
- abaleskogan20180@sbhny.direct-ci.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366848000000",
"number": "1366639007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W 150TH ST",
"address_2": "APT 701",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100392225",
"telephone_number": "617-319-4180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79-11 41ST AVE",
"address_2": "UNIT A107",
"city": "ELMHURST",
"state": "NY",
"postal_code": "11373",
"telephone_number": "718-205-2888",
"fax_number": "718-205-2855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALES-KOGAN",
"first_name": "ARIEL",
"name_prefix": "Mr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-26",
"last_updated": "2013-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "055373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.