Charles R Dennis, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

126943-1 Issued in NY

Practice address

55 Medford Ave
Suite E
Patchogue, NY 11772-1229

Phone

(631) 687-4190

Fax

(631) 687-4198

NPI assigned

Jul 4, 2006

Last updated

Feb 3, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Suffolk Surgical Group, PC

  • Surgery Physician
  • East Patchogue, NY
  • NPI 1346306750
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1578593786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 465",
            "city": "LAUREL",
            "state": "NY",
            "postal_code": "119480465",
            "telephone_number": "631-687-4190",
            "fax_number": "631-687-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MEDFORD AVE",
            "address_2": "SUITE E",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721229",
            "telephone_number": "631-687-4190",
            "fax_number": "631-687-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "126943-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00376701",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Marie Delbianco, LCSW
• Erika Delco
• Jessica Lynn Delton
• John Patrick Demartino
• Kieran Gerard Deneen
• Julie Ann Desantis-Mayer, PTA
• Brett Andrew Desing, D.C.
• Kathia Desronvil, N.P.
• Jacob Tyler Deubler, PA-C
• Jennifer Deveglio

• Surgery Physician in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.