Active NPI
Pavlos Malonoukos, DMD
- Dentist
- Merrick, NY
National Provider Identifier
1467863357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 058012
- Practice address
- 1846 Merrick Ave
Merrick, NY 11566-2730 - Phone
- (516) 378-1725
- NPI assigned
- May 13, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 058012 | NY | Primary |
Addresses
Primary practice location
1846 Merrick Ave
Merrick, NY 11566-2730
Mailing address
15748 13TH Ave
Whitestone, NY 11357-1932
Phone (917) 251-6262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04308729 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Merrick Dental Care | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Merrick, NY
- NPI 1184089062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475020800000",
"number": "1467863357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15748 13TH AVE",
"city": "WHITESTONE",
"state": "NY",
"postal_code": "113571932",
"telephone_number": "917-251-6262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1846 MERRICK AVE",
"city": "MERRICK",
"state": "NY",
"postal_code": "115662730",
"telephone_number": "516-378-1725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONOUKOS",
"first_name": "PAVLOS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-13",
"last_updated": "2016-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "058012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04308729",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merrick, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.