NPIMap

Organization Active NPI

99-04 57TH Avenue, Inc.

  • Dental Clinic/Center
  • Corona, NY
National Provider Identifier
1679977680
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0438701 Issued in NY
Legal business name
99-04 57TH AVENUE, INC.
Practice address
9904 57TH Ave
Suite LH
Corona, NY 11368-3746
Phone
(718) 760-0471
Fax
(718) 760-4739
NPI assigned
Oct 20, 2014
Organization subpart
No

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

9904 57th Ave
Ste Lh
Corona, NY 11368
Phone (718) 760-0471

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Authorized official

Name
Dr. Maria E AceboNPI 1659585990
Title
Owner
Phone
(718) 760-0471

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0438701 NY Primary

Addresses

Primary practice location

9904 57TH Ave
Suite LH
Corona, NY 11368-3746

Mailing address

9904 57TH Ave
Suite LH
Corona, NY 11368-3746
Phone (718) 760-0471

NPI Registry JSON

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1679977680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9904 57TH AVE",
            "address_2": "SUITE LH",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113683746",
            "telephone_number": "718-760-0471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9904 57TH AVE",
            "address_2": "SUITE LH",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113683746",
            "telephone_number": "718-760-0471",
            "fax_number": "718-760-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "99-04 57TH AVENUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "ACEBO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-760-0471",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "0438701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; 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.