Active NPI
Michael Robert Moynihan, DDS
- Endodontics
- Syracuse, NY
National Provider Identifier
1669663316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 045676
- Practice address
- 600 East Genesee Street
Suite #113
Syracuse, NY 13202 - Phone
- (315) 476-7406
- Fax
- (315) 476-7408
- NPI assigned
- Aug 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 045676 | NY | Primary |
Addresses
Primary practice location
600 East Genesee Street
Suite #113
Syracuse, NY 13202
Mailing address
600 East Genesee Street
Suite #113
Syracuse, NY 13202
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Dec 6, 2015 through Dec 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045676 | NY | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontic Associates PC | Endodontics | 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 and National Provider Directory roles.
-
- Endodontics
- Syracuse, NY
- NPI 1912919184
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186444800000",
"number": "1669663316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 EAST GENESEE STREET",
"address_2": "SUITE #113",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 EAST GENESEE STREET",
"address_2": "SUITE #113",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202",
"telephone_number": "315-476-7406",
"fax_number": "315-476-7408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOYNIHAN",
"first_name": "MICHAEL",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-07",
"last_updated": "2007-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "045676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2007; 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.