Individual provider Active NPI

Peter Anthony Lucchese, DDS

  • General Practice Dentistry
  • Glen Head, NY
National Provider Identifier
1669642575
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
044345 Issued in NY
Practice address
40 Railroad Ave
Glen Head, NY 11545-1839
Phone
(516) 676-0892
Fax
(516) 676-1432
NPI assigned
Mar 6, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 044345 NY Primary

Addresses

Primary practice location

40 Railroad Ave
Glen Head, NY 11545-1839

Mailing address

40 Railroad Ave
Glen Head, NY 11545-1839
Phone (516) 676-0892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625002223 NY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4486965845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
044345NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1669642575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 RAILROAD AVE",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451839",
            "telephone_number": "516-676-0892",
            "fax_number": "516-676-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 RAILROAD AVE",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451839",
            "telephone_number": "516-676-0892",
            "fax_number": "516-676-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCCHESE",
        "first_name": "PETER",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "044345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Head, NY

Sources for this page

Verify at the official NPI Registry.