Active NPI
Robert David Blank, D.M.D.
- Periodontics
- Shelter Island, NY
National Provider Identifier
1720173750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 24831
- Practice address
- 51A N. Ferry Rd.
Shelter Island, NY 11964-0715 - Phone
- (631) 749-2646
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 24831 | NY | Primary |
Addresses
Primary practice location
51A N. Ferry Rd.
Shelter Island, NY 11964-0715
Mailing address
56 N. Cartwright Rd.
Pob 715
Shelter Island, NY 11964-0715
Phone (631) 749-2117
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 |
|---|---|---|---|
| 24831 | NY | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720173750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 N. CARTWRIGHT RD.",
"address_2": "POB 715",
"city": "SHELTER ISLAND",
"state": "NY",
"postal_code": "119640715",
"telephone_number": "631-749-2117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51A N. FERRY RD.",
"city": "SHELTER ISLAND",
"state": "NY",
"postal_code": "119640715",
"telephone_number": "631-749-2646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "ROBERT",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "24831",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelter Island, 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.