Ian Wall

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

064923 Issued in NY

Practice address

216 Sea Cliff Ave
Sea Cliff, NY 11579-1232

Phone

(363) 777-9690

NPI assigned

Apr 4, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1617494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1659950061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CLAIRE LN",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117822420",
            "telephone_number": "631-766-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 SEA CLIFF AVE",
            "city": "SEA CLIFF",
            "state": "NY",
            "postal_code": "115791232",
            "telephone_number": "363-777-9690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "IAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-04",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN10000220",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417767",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "064923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelia Tully
• Athena Vaccaro, M.S., P.T
• Nancy Warren Van Dyke, LCSW
• Pia Theresa Viana, SLP
• Judith Voelpel, MS CCC-SLP
• Marianne F Walters, PH.D.
• Jacqueline Maria Warren, LCSW, CASAC
• Marguerite Weisberg, LCSW
• Elizabeth Anne Wezwick, MS
• Donna Davis Whelan, SLP

• General Practice Dentistry in Sea Cliff, NY
• Providers in Sea Cliff, 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 Aug 6, 2025; 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.