John Edward Fantasia, D.D.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

041799-1 Issued in NY

Practice address

27005 76TH Ave
Lijmc
New Hyde Park, NY 11040-1433

Phone

(718) 470-7116

Fax

(718) 347-3483

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Dentist, Maxillofacial Surgery

Education

Emory University School of Medicine, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Hall Dental, PCGroup PAC ID 2567820137, 10 clinicians

Black Hall Dental PCGroup PAC ID 6901283308, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

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.

• Black Hall Dental, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Manhasset, NY
  • NPI 1356091516
  Medicare reassignment Care Compare group NPD
• White Hall Dental, PC

  • Dentist
  • New Hyde Park, NY
  • NPI 1376268821

  Oral and Maxillofacial Pathology

  Medicare reassignment Care Compare group NPD
• North Shore Long Island Jewish Healthcare

  • Cardiovascular Disease Physician
  • Westbury, NY
  • NPI 1215019500
  Medicare reassignment NPD
• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD
• Black Hall Dental, P.C.

  • Dentist
  • New Hyde Park, NY
  • NPI 1336991876
  NPD
• North Shore Long Island Jewish Health Care Inc

  • Internal Medicine Physician
  • New York, NY
  • NPI 1912338385
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  Care Compare affiliation

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730258286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27005 76TH AVE",
            "address_2": "LIJMC",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401433",
            "telephone_number": "718-470-7116",
            "fax_number": "718-347-3483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27005 76TH AVE",
            "address_2": "LIJMC",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401433",
            "telephone_number": "718-470-7116",
            "fax_number": "718-347-3483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTASIA",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NY",
            "license": "041799-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01098053",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Marie Falzone, RPA-C
• Sina Famenini, MD, MPH
• Jacqueline Famiglietti, CRNA
• Family Ophthalmology of Long Island, PC
• Nancy Fan, DO
• Victoria Faraci
• Sara Farag, M.D.
• Kristin Ann Faranda
• Nikita Farhadi
• Sakina Farhat, M.D

• Oral and Maxillofacial Pathology Dentistry in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Oral and Maxillofacial Pathology Dentistry in New York

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.