NPIMap

Organization Active NPI

Wyckoff Heights Dental Services P.C.

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1447298070
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WYCKOFF HEIGHTS DENTAL SERVICES P.C.
Practice address
374 Stockholm St
Brooklyn, NY 11237-4006
Phone
(718) 963-7174
Fax
(718) 302-6744
NPI assigned
Jun 4, 2006
Last updated
Apr 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Authorized official

Name
Ms. Vali Gache
Title
Cfo
Phone
(718) 240-1795

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X
Endodontics 1223E0200X
General Practice Dentistry 1223G0001X Primary
Pediatric Dentistry 1223P0221X
Periodontics 1223P0300X
Prosthodontics 1223P0700X
Oral and Maxillofacial Surgery (Dentist) 1223S0112X
Dental Anesthesiology 1223D0004X

Addresses

Primary practice location

374 Stockholm St
Brooklyn, NY 11237-4006

Mailing address

374 Stockholm St
Brooklyn, NY 11237-4006
Phone (718) 963-7174

Other practice location 1

1411 Myrtle Ave
Brooklyn, NY 11237-4512
Phone (718) 963-7676

Other identifiers 1

IdentifierTypeStateIssuer
01894164MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141107000080 NY Part B Supplier - Clinic/Group Practice 0749402782 Receives reassigned benefits from 19 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory
Tax ID family
Wyckoff Heights Dental Services PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1447298070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7174",
            "fax_number": "718-302-6744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7174",
            "fax_number": "718-302-6744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 Myrtle Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112374512",
            "country_code": "US",
            "telephone_number": "718-963-7676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYCKOFF HEIGHTS DENTAL SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "GACHE",
        "authorized_official_first_name": "VALI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-240-1795",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01894164",
            "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 Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.