Active NPI
Robert A Convissar, D.D.S.
- General Practice Dentistry
- Great Neck, NY
National Provider Identifier
1609932797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35183
- Practice address
- 26 W Terrace Rd
Great Neck, NY 11021-1514 - Phone
- (516) 987-5707
- NPI assigned
- Dec 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 35183 | NY | Primary |
Addresses
Primary practice location
26 W Terrace Rd
Great Neck, NY 11021-1514
Mailing address
26 W Terrace Rd
Great Neck, NY 11021-1514
Phone (516) 987-5707
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 |
|---|---|---|---|
| 35183 | NY | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Convissar and Goldstein DDS | General Practice | 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 and National Provider Directory roles.
-
- General Practice Dentistry
- New York, NY
- NPI 1417013509
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1609932797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 W TERRACE RD",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110211514",
"telephone_number": "516-987-5707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 W TERRACE RD",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110211514",
"telephone_number": "516-987-5707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONVISSAR",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-31",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "35183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.