Individual provider Active NPI

Edgar P Fayans, D.D.S.

  • Dentist
  • Oceanside, NY
National Provider Identifier
1528106986
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
037304 Issued in NY
Practice address
255 Sunnyside Rd
Oceanside, NY 11572-3342
Phone
(516) 763-4996
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 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 037304 NY Primary

Addresses

Primary practice location

255 Sunnyside Rd
Oceanside, NY 11572-3342

Mailing address

255 Sunnyside Rd
Oceanside, NY 11572-3342
Phone (516) 763-4996

Other identifiers 1

IdentifierTypeStateIssuer
00948132MedicaidNY

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
I20160622001611 NY Order and Referring Only - DentistPractitioner - Dentist 4688965676

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
037304NYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1528106986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 SUNNYSIDE RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115723342",
            "telephone_number": "516-763-4996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 SUNNYSIDE RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115723342",
            "telephone_number": "516-763-4996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAYANS",
        "first_name": "EDGAR",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "037304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00948132",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, NY

Sources for this page

Verify at the official NPI Registry.