Pediatric Dentistry of Long Island

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

041152 Issued in NY

Legal business name

PEDIATRIC DENTISTRY OF LONG ISLAND

Practice address

1719 N Ocean Ave Ste C
Medford, NY 11763-2669

Phone

(631) 654-4242

Fax

(631) 654-4291

NPI assigned

Feb 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Scott Louis Goldstein, DDS

Title

Ceo

Phone

(631) 654-4242

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423785600000",
    "number": "1629469499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 N OCEAN AVE STE C",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632669",
            "telephone_number": "631-654-4242",
            "fax_number": "631-654-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 N OCEAN AVE STE C",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632669",
            "telephone_number": "631-654-4242",
            "fax_number": "631-654-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF LONG ISLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2015-02-13",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-654-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "041152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Parnell
• Sarah S Parsley, LPN
• Shermille J Pascall
• Patchogue-Medford School District
• Patchogue-Medford School District
• Pediatric Dentistry of Suffolk County II
• Awilda Pelaez, LMT
• Rachel L Peralta
• Mashiwa Roukyia Percer, LPN
• Adriana Perez

• Dental Clinic/Center in Medford, NY
• Providers in Medford, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; 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.