Joseph S Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0511251 Issued in NY

Practice address

412 State Route 37
Hogansburg, NY 13655-3109

Phone

(518) 358-3141

Fax

(518) 358-2797

NPI assigned

Nov 2, 2005

Last updated

Mar 25, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Regis Mohawk Tribe

  dba St Regis Mohawk Health Services

  • Federally Qualified Health Center (FQHC)
  • Akwesasne, NY
  • NPI 1457344558
  Medicare reassignment NPD

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1396736989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 STATE ROUTE 37",
            "city": "HOGANSBURG",
            "state": "NY",
            "postal_code": "136553109",
            "telephone_number": "518-358-3141",
            "fax_number": "518-358-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 STATE ROUTE 37",
            "city": "HOGANSBURG",
            "state": "NY",
            "postal_code": "136553109",
            "telephone_number": "518-358-3141",
            "fax_number": "518-358-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOSEPH",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0511251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852708",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89875818",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03078080",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44007027",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael William Lynch, M.D.
• Verda Marie Lyons, RN
• Christina Jean-Marie McCarthy
• Debra Ann Meness, M.D., D.O.
• Alyssa N Moore, PA-C
• Lacey S Peters, RN
• Phoenix Physical Therapy & Pta PLLC
• Heather Marie Pontius, R.D.
• Hillary Jill Pyke, O.D.
• Emmanuel Augusto Quinan, P.T.

• Dentist in Hogansburg, NY
• Providers in Hogansburg, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.