Active NPI
Roberta Grill Deutsch, D.D.S.
- Periodontics
- New York, NY
National Provider Identifier
1417904640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 034467
- Practice address
- 250 W 57TH St
Suite 2130
New York, NY 10107-0001 - Phone
- (212) 315-2102
- Fax
- (212) 315-0018
- NPI assigned
- May 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 034467 | NY | Primary |
Addresses
Primary practice location
250 W 57TH St
Suite 2130
New York, NY 10107-0001
Mailing address
250 W 57TH St
Suite 2130
New York, NY 10107-0001
Phone (212) 315-2102
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181206002869 | NY | Order and Referring Only - Dentist | 3779827472 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034467 | NY | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1417904640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 W 57TH ST",
"address_2": "SUITE 2130",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101070001",
"telephone_number": "212-315-2102",
"fax_number": "212-315-0018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 W 57TH ST",
"address_2": "SUITE 2130",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101070001",
"telephone_number": "212-315-2102",
"fax_number": "212-315-0018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRILL DEUTSCH",
"first_name": "ROBERTA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "034467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.