NPIMap

Organization Active NPI

Victoria E. Shack, DDS, PC

  • Dentist
  • Port Jefferson Station, NY
National Provider Identifier
1366896466
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
056759 Issued in NY
Legal business name
VICTORIA E. SHACK, DDS, PC
Practice address
3 Medical Dr
Suite D
Port Jefferson Station, NY 11776-1597
Phone
(631) 928-7500
NPI assigned
Apr 15, 2016
Last updated
Apr 15, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2016

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

Authorized official

Name
Dr. Victoria Elena Shack, DDSNPI 1538427802
Title
President
Phone
(631) 928-7500

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
Dentist 122300000X 056759 NY Primary

Addresses

Primary practice location

3 Medical Dr
Suite D
Port Jefferson Station, NY 11776-1597

Mailing address

3 Medical Dr
Suite D
Port Jefferson Station, NY 11776-1597
Phone (631) 928-7500

National Provider Directory

National Provider Directory

Locations

3 Medical Dr
Ste D
Port Jefferson Station, NY 11776
Phone (631) 928-7500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1366896466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR",
            "address_2": "SUITE D",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-928-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR",
            "address_2": "SUITE D",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-928-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIA E. SHACK, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-15",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "SHACK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "ELENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-928-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "056759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.