NPIMap

Organization Active NPI

Pavel Niderman D.D.S Atlantic Dental

  • Dentist
  • New York, NY
National Provider Identifier
1437372380
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
044976 Issued in NY
Legal business name
PAVEL NIDERMAN D.D.S ATLANTIC DENTAL
Practice address
2060 Lexington Ave FRNT 2
New York, NY 10035-1759
Phone
(212) 996-5996
Fax
(212) 996-0030
NPI assigned
Apr 10, 2007
Last updated
Jul 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

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

Authorized official

Name
Dr. Pavel Niderman, DDSNPI 1992794267
Title
President
Phone
(212) 996-5996

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 044976 NY Primary
General Practice Dentistry 1223G0001X 044976 NY
Periodontics 1223P0300X 048519 NY

Addresses

Primary practice location

2060 Lexington Ave FRNT 2
New York, NY 10035-1759

Mailing address

2060 Lexington Ave FL 2ND
New York, NY 10035-1759
Phone (212) 996-5996

Other identifiers 1

IdentifierTypeStateIssuer
02241298MedicaidNY

National Provider Directory

National Provider Directory

Locations

2060 Lexington Ave
Frnt 2
New York, NY 10035
Phone (212) 996-5996

Practitioners & affiliated clinicians

Practitioners 5

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": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1437372380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 LEXINGTON AVE FL 2ND",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351759",
            "telephone_number": "212-996-5996",
            "fax_number": "212-996-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 LEXINGTON AVE FRNT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351759",
            "telephone_number": "212-996-5996",
            "fax_number": "212-996-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVEL NIDERMAN D.D.S ATLANTIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "NIDERMAN",
        "authorized_official_first_name": "PAVEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-996-5996",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "044976",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "044976",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "048519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02241298",
            "state": "NY"
        }
    ],
    "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 20, 2020; 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.