Active NPI
Neal B Nissen, D.D.S.
- Pediatric Dentistry
- Brooklyn, NY
National Provider Identifier
1376608976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 033959-1
- Practice address
- 2005 Avenue L
Apt. 1F
Brooklyn, NY 11210-4550 - Phone
- (718) 338-0015
- NPI assigned
- Dec 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 033959-1 | NY | Primary |
Addresses
Primary practice location
2005 Avenue L
Apt. 1F
Brooklyn, NY 11210-4550
Mailing address
2005 Avenue L
Apt. 1F
Brooklyn, NY 11210-4550
Phone (718) 338-0015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00412579 | Medicaid | NY |
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 |
|---|---|---|---|
| 033959-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376608976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 AVENUE L",
"address_2": "APT. 1F",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112104550",
"telephone_number": "718-338-0015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 AVENUE L",
"address_2": "APT. 1F",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112104550",
"telephone_number": "718-338-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISSEN",
"first_name": "NEAL",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "033959-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00412579",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.