Active NPI
Mark Steven Cerrachio, DDS
- General Practice Dentistry
- Brooklyn, NY
National Provider Identifier
1578774071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34502
- Practice address
- 774 Carroll St
Brooklyn, NY 11215-1403 - Phone
- (718) 622-7231
- Fax
- (718) 622-7224
- NPI assigned
- May 25, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34502 | NY | Primary |
Addresses
Primary practice location
774 Carroll St
Brooklyn, NY 11215-1403
Mailing address
26 Joseph LN
Staten Island, NY 10305-2825
Phone (718) 981-2123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34502 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578774071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 JOSEPH LN",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103052825",
"telephone_number": "718-981-2123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "774 CARROLL ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112151403",
"telephone_number": "718-622-7231",
"fax_number": "718-622-7224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERRACHIO",
"first_name": "MARK",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "34502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.