Individual provider Active NPI

Gregory Jerome Haskin, D.D.S.

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1568444057
Registry record updated May 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
039964-1 Issued in NY
Practice address
4571 Kings Hwy
Brooklyn, NY 11234-2025
Phone
(718) 692-4791
Fax
(718) 692-3362
NPI assigned
Nov 18, 2005
Last updated
May 6, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 039964-1 NY Primary

Addresses

Primary practice location

4571 Kings Hwy
Brooklyn, NY 11234-2025

Mailing address

4571 Kings Hwy
Brooklyn, NY 11234-2025
Phone (718) 692-4791

Other identifiers 1

IdentifierTypeStateIssuer
949106MedicaidNY

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
I20151014001185 NY Order and Referring Only - DentistPractitioner - Dentist 4587973508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
039964-1NYMDGeneral Practice Dentistry
039964NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gregory J Haskin DDS PC 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1568444057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4571 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342025",
            "telephone_number": "718-692-4791",
            "fax_number": "718-692-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4571 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342025",
            "telephone_number": "718-692-4791",
            "fax_number": "718-692-3362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKIN",
        "first_name": "GREGORY",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039964-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "949106",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.