Active NPI
Leo A Massaro, DDS
- Dentist
- Liverpool, NY
National Provider Identifier
1720257033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 048562
- Practice address
- 4820 W Taft Rd
Suite 102
Liverpool, NY 13088-2800 - Phone
- (315) 451-5500
- Fax
- (315) 451-5507
- NPI assigned
- Feb 21, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 048562 | NY | Primary |
Addresses
Primary practice location
4820 W Taft Rd
Suite 102
Liverpool, NY 13088-2800
Mailing address
4820 W Taft Rd
Suite 102
Liverpool, NY 13088-2800
Phone (315) 451-5500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2015 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048562 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1720257033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4820 W TAFT RD",
"address_2": "SUITE 102",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130882800",
"telephone_number": "315-451-5500",
"fax_number": "315-451-5507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 W TAFT RD",
"address_2": "SUITE 102",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130882800",
"telephone_number": "315-451-5500",
"fax_number": "315-451-5507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSARO",
"first_name": "LEO",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-21",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "048562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.