Modern Dental Concepts of Ny, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049260-1 Issued in NY

Legal business name

MODERN DENTAL CONCEPTS OF NY, PC

Practice address

1595 Straight Path
Wyandanch, NY 11798-2407

Phone

(516) 343-2772

NPI assigned

Apr 1, 2008

Organization subpart

No

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

Authorized official

Name

Leonid Reznik, DDSNPI 1346447307

Title

President

Phone

(516) 343-2772

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leonid Reznik, D.D.S

  • General Practice Dentistry
  • Wyandanch, NY
  • NPI 1346447307
  Authorized official Same address or phone

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1609048461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 STRAIGHT PATH",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "117982407",
            "telephone_number": "516-343-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 STRAIGHT PATH",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "117982407",
            "telephone_number": "516-343-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL CONCEPTS OF NY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "REZNIK",
        "authorized_official_first_name": "LEONID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-343-2772",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049260-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02156141",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly McNulty
• Kristi Mercado
• Diane Louise Mercer, CASAC-T
• Fafart Michel, LPN
• Robert Miles, CASAC-T
• Donna Moodie, RD CDE
• Thomas Haywood Moore, PT, DPT
• Vermilyea Moore
• Mor Drugs Inc
• Lazara Morejon, LMSW

• General Practice Dentistry in Wyandanch, NY
• Providers in Wyandanch, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.