NPIMap

Organization Active NPI

Kirshenbaum Peruso Kautman LLP

  • Dentist
  • Central Islip, NY
National Provider Identifier
1720160690
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
KIRSHENBAUM PERUSO KAUTMAN LLP
Practice address
109 Carleton Ave
Central Islip, NY 11722
Phone
(631) 348-2500
Fax
(631) 234-4324
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. William Joseph Peruso, DDSNPI 1093897969
Title
Partner
Phone
(631) 348-2500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

109 Carleton Ave
Central Islip, NY 11722

Mailing address

109 Carleton Ave
Central Islip, NY 11722
Phone (631) 348-2500

Other identifiers 1

IdentifierTypeStateIssuer
01808433MedicaidNY

Other names 1

  • Carleton Ave Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

109 Carleton Ave
Central Islip, NY 11722
Phone (631) 348-2500

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720160690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "11722",
            "telephone_number": "631-348-2500",
            "fax_number": "631-234-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "11722",
            "telephone_number": "631-348-2500",
            "fax_number": "631-234-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRSHENBAUM PERUSO KAUTMAN LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PERUSO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "631-348-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01808433",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carleton Ave Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Central Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.