Individual provider Active NPI

Dana Yusupov

  • Dentist
  • East Meadow, NY
National Provider Identifier
1477050193
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
060787 Issued in NY
Practice address
2201 Hempstead Tpke
East Meadow, NY 11554-1859
Phone
(718) 864-4574
NPI assigned
Apr 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 060787 NY Primary

Addresses

Primary practice location

2201 Hempstead Tpke
East Meadow, NY 11554-1859

Mailing address

2201 Hempstead Tpke
East Meadow, NY 11554-1859

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210518001590 NY Practitioner - Dentist 4183961626 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
060787NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Charles Evans Center, Inc. CurrentSince Apr 1, 2021 Accepting new patients
Joseph P. Addabbo Family Health Center, Inc. Current Accepting new patients
Charles Evans Center, Inc CurrentSince Apr 1, 2021 Accepting new patients
Joseph P. Addabbo Family Health Center, Inc. Current Accepting new patients
Joseph P. Addabbo Family Health Center, Inc. CurrentSince Jul 29, 2024 Accepting new patients
Joseph P. Addabbo Family Health Center, Inc. CurrentSince Jul 29, 2024 Accepting new patients

Locations

6200 Beach Channel Dr
Fl 3
Arverne, NY 11692
Phone (929) 995-0733

6200 Beach Channel Dr
Arverne, NY 11692
Phone (718) 945-2400

857 S Oyster Bay Rd
Bethpage, NY 11714
Phone (516) 622-8888

1288 Central Ave
Far Rockaway, NY 11691
Phone (718) 327-1700

113 Glen Cove Ave
Glen Cove, NY 11542
Phone (516) 622-8888

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1477050193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 HEMPSTEAD TPKE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115541859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 HEMPSTEAD TPKE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115541859",
            "telephone_number": "718-864-4574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUSUPOV",
        "first_name": "DANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-09",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "060787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Meadow, NY

Sources for this page

Verify at the official NPI Registry.