Active NPI
Paul Eliazo, DDS
- General Practice Dentistry
- Suffern, NY
National Provider Identifier
1710033469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0502661
- Practice address
- 2 Executive Blvd
Suite 400a
Suffern, NY 10901-4164 - Phone
- (845) 369-8100
- Fax
- (845) 369-8100
- NPI assigned
- Jan 26, 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 | 0502661 | NY | Primary |
Addresses
Primary practice location
2 Executive Blvd
Suite 400a
Suffern, NY 10901-4164
Mailing address
2 Executive Blvd
Suite 400a
Suffern, NY 10901-4164
Phone (845) 369-8100
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 |
|---|---|---|---|
| 0502661 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360713600000",
"number": "1710033469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 EXECUTIVE BLVD",
"address_2": "SUITE 400A",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014164",
"telephone_number": "845-369-8100",
"fax_number": "845-369-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 EXECUTIVE BLVD",
"address_2": "SUITE 400A",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014164",
"telephone_number": "845-369-8100",
"fax_number": "845-369-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIAZO",
"first_name": "PAUL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2013-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "0502661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.