Active NPI
Dmitry Nikitayev, D.D.S.
- Dentist
- Brooklyn, NY
National Provider Identifier
1588945000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 055734-1
- Practice address
- 760 Broadway
Woodhull Medical & Mental Health Center
Brooklyn, NY 11206 - Phone
- (718) 963-8000
- NPI assigned
- Aug 30, 2011
- Last updated
- Aug 8, 2014
- 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 | 055734-1 | NY | Primary |
Addresses
Primary practice location
760 Broadway
Woodhull Medical & Mental Health Center
Brooklyn, NY 11206
Mailing address
133 Bassett Avenue
Brooklyn, NY 11234-6734
Phone (718) 209-5949
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111116000123 | NY | Order and Referring Only - Oral Surgery | 1850565516 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055734-1 | NY | MD | Dentist |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- dnikitayev562774@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407456000000",
"number": "1588945000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 BASSETT AVENUE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112346734",
"telephone_number": "718-209-5949",
"fax_number": "718-630-3122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 BROADWAY",
"address_2": "WOODHULL MEDICAL & MENTAL HEALTH CENTER",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11206",
"telephone_number": "718-963-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKITAYEV",
"first_name": "DMITRY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-30",
"last_updated": "2014-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055734-1",
"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 Aug 8, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.