Individual provider Active NPI

Jacob Nagelblatt, D.D.S.

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1700987914
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
036780 Issued in NY
Practice address
1524 56TH St
Brooklyn, NY 11219-4737
Phone
(718) 851-0910
Fax
(718) 851-3897
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
Yes

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 036780 NY Primary

Addresses

Primary practice location

1524 56TH St
Brooklyn, NY 11219-4737

Mailing address

1540 East 21 St
Brooklyn, NY 11210-5036
Phone (718) 851-0910

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

LicenseStateTypeSpecialty
036780NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700987914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 EAST 21 ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112105036",
            "telephone_number": "718-851-0910",
            "fax_number": "718-851-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 56TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112194737",
            "telephone_number": "718-851-0910",
            "fax_number": "718-851-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGELBLATT",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "036780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, 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.

Verify at the official NPI Registry.