Individual provider Active NPI

Patricia Maureen Hanlon, D.M.D.

  • Pediatric Dentistry
  • Riverhead, NY
National Provider Identifier
1649393885
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
39273 Issued in NY
Practice address
1149 Old Country Rd
Suite B-1
Riverhead, NY 11901-2057
Phone
(631) 369-0300
Fax
(631) 369-0301
NPI assigned
Apr 10, 2007
Last updated
Nov 29, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 39273 NY Primary

Addresses

Primary practice location

1149 Old Country Rd
Suite B-1
Riverhead, NY 11901-2057

Mailing address

1149 Old Country Rd
Suite B-1
Riverhead, NY 11901-2057
Phone (631) 369-0300

Other identifiers 1

IdentifierTypeStateIssuer
00909917MedicaidNY

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

LicenseStateTypeSpecialty
39273NYMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hanlon&Sanders DMD PC Pediatric Dentistry 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1649393885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 OLD COUNTRY RD",
            "address_2": "SUITE B-1",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012057",
            "telephone_number": "631-369-0300",
            "fax_number": "631-369-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 OLD COUNTRY RD",
            "address_2": "SUITE B-1",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012057",
            "telephone_number": "631-369-0300",
            "fax_number": "631-369-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLON",
        "first_name": "PATRICIA",
        "middle_name": "MAUREEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "39273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00909917",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.