Individual provider Active NPI

Gildo Renzo Corradi, DDS

  • Dentist
  • New York, NY
National Provider Identifier
1497814925
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
050955 Issued in NY
Practice address
200 W 57TH St
Suite1405
New York, NY 10019-3211
Phone
(212) 757-3879
Fax
(212) 757-2548
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 050955 NY Primary

Addresses

Primary practice location

200 W 57TH St
Suite1405
New York, NY 10019-3211

Mailing address

200 W 57TH St
Suite1405
New York, NY 10019-3211
Phone (212) 757-3879

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
I20160314001483 NY Order and Referring Only - DentistPractitioner - Dentist 9638475858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
050955NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497814925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 57TH ST",
            "address_2": "SUITE1405",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100193211",
            "telephone_number": "212-757-3879",
            "fax_number": "212-757-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W 57TH ST",
            "address_2": "SUITE1405",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100193211",
            "telephone_number": "212-757-3879",
            "fax_number": "212-757-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORRADI",
        "first_name": "GILDO",
        "middle_name": "RENZO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "050955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.