Active NPI
Pericles Rountos, DMD
- General Practice Dentistry
- New York, NY
National Provider Identifier
1699805879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 050102-1
- Practice address
- 2253 3Rd Ave
New York, NY 10035-2206 - Phone
- (212) 289-6650
- NPI assigned
- Mar 6, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 050102-1 | NY | Primary |
Addresses
Primary practice location
2253 3Rd Ave
New York, NY 10035-2206
Mailing address
2236 74TH St
East Elmhurst, NY 11370-1106
Phone (917) 254-8244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 050102-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699805879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2236 74TH ST",
"city": "EAST ELMHURST",
"state": "NY",
"postal_code": "113701106",
"telephone_number": "917-254-8244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2253 3RD AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100352206",
"telephone_number": "212-289-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUNTOS",
"first_name": "PERICLES",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "050102-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.