Anthony Disanti, DDS
Individual provider Active NPI Endodontics · Selden, NY
NPI 1699861724 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1699861724
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 036484 (NY)
- Practice address
- 280 Middle Country Rd Ste K
Selden, NY 11784-2532 - Phone
- (631) 732-9000
- Fax
- (631) 736-7982
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160608001918 | NY | Order and Referring Only - Dentist |
6406146182 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036484 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coarm-Selden Dental Group | Past | Accepting new patients | |
| Coram Selden Dental Group PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 036484 | NY | Yes |
Addresses
Primary practice location
280 Middle Country Rd Ste K
Selden, NY 11784-2532
Mailing address
280 Middle Country Rd Ste K
Selden, NY 11784-2532
Phone (631) 732-9000
Other providers in Selden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.