Individual provider Active NPI

Joseph Lemuel De Leon, DMD

  • Dentist
  • Brentwood, NY
National Provider Identifier
1720232143
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
060985 Issued in NY
Practice address
1869 Brentwood Rd
Brentwood, NY 11717-4625
Phone
(631) 416-5480
Fax
(631) 994-2900
NPI assigned
Nov 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN1857105 MA
General Practice Dentistry 1223G0001X 9813 MA
Dentist 122300000X 060985 NY Primary

Addresses

Primary practice location

1869 Brentwood Rd
Brentwood, NY 11717-4625

Mailing address

PO Box 5036
White Plains, NY 10602-5036
Phone (924) 898-9421

Other practice location 1

31 Park Dr
Apt 9
Boston, MA 02215-4916
Phone (413) 835-5268

Other identifiers 1

IdentifierTypeStateIssuer
06551766MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180117002452 MA Practitioner - Dentist 3476849068 Reassigns benefits to 1 organization
I20210723000306 NY Practitioner - Dentist 3476849068 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
060985NYMDDentist
9813MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sun River Health Inc. CurrentSince Jul 12, 2021 Accepting new patients
Brigham & Womens Hospital, Inc. CurrentSince Jan 2, 2017 Accepting new patients
Sun River Health Inc Current Accepting new patients

Locations

75 Francis St
Boston, MA 02115

375 Boylston St
Brookline, MA 02445
Phone (508) 718-4010

399 Revolution Dr
Somerville, MA 02145
Phone (800) 856-1983

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

6 Henry St
Beacon, NY 12508
Phone (845) 831-0400

1869 Brentwood Rd
Brentwood, NY 11717
Phone (631) 416-5480

1200 Brown St
Peekskill, NY 10566
Phone (845) 838-7020

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1720232143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5036",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106025036",
            "telephone_number": "924-898-9421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1869 BRENTWOOD RD",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174625",
            "telephone_number": "631-416-5480",
            "fax_number": "631-994-2900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Park Dr",
            "address_2": "Apt 9",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022154916",
            "country_code": "US",
            "telephone_number": "413-835-5268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LEON",
        "first_name": "JOSEPH",
        "middle_name": "LEMUEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-12",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1857105",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "9813",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "060985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06551766",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, NY

Sources for this page

Verify at the official NPI Registry.