Individual provider Active NPI

Evan Michael Homburger, DDS

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1679607600
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043895 Issued in NY
Practice address
9915 Seaview Ave
Brooklyn, NY 11236-5525
Phone
(718) 763-7799
Fax
(718) 763-7846
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 043895 NY Primary

Addresses

Primary practice location

9915 Seaview Ave
Brooklyn, NY 11236-5525

Mailing address

9915 Seaview Ave
Brooklyn, NY 11236-5525
Phone (718) 763-7799

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
I20150525000013 NY Order and Referring Only - DentistPractitioner - Dentist 8123348612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
043895NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679607600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9915 SEAVIEW AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112365525",
            "telephone_number": "718-763-7799",
            "fax_number": "718-763-7846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9915 SEAVIEW AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112365525",
            "telephone_number": "718-763-7799",
            "fax_number": "718-763-7846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMBURGER",
        "first_name": "EVAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.