Roosevelt 26 Dental Group PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

ROOSEVELT 26 DENTAL GROUP PLLC

Practice address

10308 Roosevelt Ave
Corona, NY 11368-2330

Phone

(917) 391-8000

NPI assigned

Apr 9, 2019

Organization subpart

No

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

Authorized official

Name

Faramarz Khalili, DDS

Title

Owner

Phone

(516) 382-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: alicia@dyny26.com

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1407319239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10308 ROOSEVELT AVE",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682330",
            "telephone_number": "917-391-8000",
            "fax_number": "718-397-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10308 ROOSEVELT AVE",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682330",
            "telephone_number": "917-391-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT 26 DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "KHALILI",
        "authorized_official_first_name": "FARAMARZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-382-8000",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03060184",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Alicia@dyny26.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10308 Roosevelt Ave",
            "city": "Corona",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113682330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deloise Rogers, RN
• Laura V Rojas Mena, LCSW
• Jonathan Roman, NURSE PRACTITIONER
• Marlee Roman
• Marie Rondeau
• Roosevelt 26 Dentistry P.C.
• Roosevelt Dental Care III P.C.
• Roosevelt Orthodontics
• Stephanie Ann Klajbor Rossetti, MS, CCC-SLP
• Alissa Susan Roy, PHARM.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Corona, NY
• Providers in Corona, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.