Travis James Mackey

Primary specialty

DentistTaxonomy code 122300000X

License

062492 Issued in NY

Practice address

496 County Road 111 BLDG F
Manorville, NY 11949-3383

Phone

(631) 929-5855

NPI assigned

Apr 17, 2021

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pure Dental of Long Island PC

  • General Practice Dentistry
  • Manorville, NY
  • NPI 1114133345
  NPD (past)

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

{
    "created_epoch": "1618617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1760063135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 WISCONSIN AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768012",
            "telephone_number": "631-942-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 COUNTY ROAD 111 BLDG F",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119493383",
            "telephone_number": "631-929-5855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Belle Terre Rd",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson",
            "state": "NY",
            "postal_code": "117771968",
            "country_code": "US",
            "telephone_number": "631-474-6553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "TRAVIS",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-17",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "062492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas John Lombardi
• Long Island Select Healthcare, Inc.
• Long Island Select Healthcare, Inc.
• Jason Long, ATC
• Niesje Liberte Lowne, RN
• Taylor Rae Madlinger, PA
• Jasmin Maghsoudlou, FNP
• Cristina Mancuso
• Tamiryn Mannix
• Manorville Community Ambulance Inc

• Dentist in Manorville, NY
• Providers in Manorville, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.