Active NPI
Edmund T Zysik Jr., D.D.S.
- Dentist
- Massena, NY
National Provider Identifier
1538250444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 034671
- Practice address
- 67 E Orvis St
Massena, NY 13662-2007 - Phone
- (315) 764-1867
- Fax
- (315) 764-1093
- NPI assigned
- Sep 27, 2006
- 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 | 034671 | NY | Primary |
Addresses
Primary practice location
67 E Orvis St
Massena, NY 13662-2007
Mailing address
67 E Orvis St
Massena, NY 13662-2007
Phone (315) 764-1867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 8, 2015 through Dec 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034671 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Current Dental LLC | Current | Accepting new patients |
Locations
67 E Orvis St
Massena, NY 13662
Phone (315) 764-1867
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.
-
- General Practice Dentistry
- Massena, NY
- NPI 1871442640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538250444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 E ORVIS ST",
"city": "MASSENA",
"state": "NY",
"postal_code": "136622007",
"telephone_number": "315-764-1867",
"fax_number": "315-764-1093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 E ORVIS ST",
"city": "MASSENA",
"state": "NY",
"postal_code": "136622007",
"telephone_number": "315-764-1867",
"fax_number": "315-764-1093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZYSIK",
"first_name": "EDMUND",
"middle_name": "T",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "034671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.