Jacqueline A Sobota, DMD, PHD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

055300-1 Issued in NY

Practice address

875 Mamaroneck Ave
Suite 302
Mamaroneck, NY 10543-1900

Phone

(914) 835-6004

NPI assigned

Jul 28, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 3, 2014 through Dec 3, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• American Mobile Dental, P.C.

  • General Practice Dentistry
  • Oneonta, NY
  • NPI 1700943750
  NPD (past)

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1669603411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MAMARONECK AVE",
            "address_2": "SUITE 302",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431900",
            "telephone_number": "914-835-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MAMARONECK AVE",
            "address_2": "SUITE 302",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431900",
            "telephone_number": "914-835-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBOTA",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-28",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "055300-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03632684",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella Sitner-Medvedovsky
• Small Talk Speech-Language Pathology
• Haley Smallwood, PA
• Marion Smith
• Marquitah Snowball
• Soho Diagnostics Ink Corporation
• Seneca Ryan Soler II
• Lauren Somai
• Sonographics Imaging Inc
• Fatima Nourha Soumahoro

• General Practice Dentistry in Mamaroneck, NY
• Providers in Mamaroneck, 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 Feb 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.