Individual provider Active NPI

Deborah Ann Hauerstock

  • Oral and Maxillofacial Surgery (Dentist)
  • New York, NY
National Provider Identifier
1710064472
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
047012 Issued in NY
Practice address
525 E 68TH St
Suite F2132, Mailbox 275
New York, NY 10021-4870
Phone
(212) 746-5175
Fax
(212) 746-8400
NPI assigned
Nov 1, 2006
Sex
Female
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
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 047012 NY Primary

Addresses

Primary practice location

525 E 68TH St
Suite F2132, Mailbox 275
New York, NY 10021-4870

Mailing address

525 E 68TH St
Suite F2132, Mailbox 275
New York, NY 10021-4870
Phone (212) 746-5175

Other identifiers 1

IdentifierTypeStateIssuer
047012OtherNYLICENSE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
047012NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710064472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "address_2": "SUITE F2132, MAILBOX 275",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214870",
            "telephone_number": "212-746-5175",
            "fax_number": "212-746-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "address_2": "SUITE F2132, MAILBOX 275",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214870",
            "telephone_number": "212-746-5175",
            "fax_number": "212-746-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUERSTOCK",
        "first_name": "DEBORAH",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "047012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "047012",
            "state": "NY"
        }
    ],
    "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.

Verify at the official NPI Registry.