Active NPI
Keren Etzion
- Pediatric Dentistry
- New York, NY
National Provider Identifier
1770908287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 058726
- Practice address
- 192 E 75TH St
Keren Etzion C/O Smiles 4 Kids
New York, NY 10021-3242 - Phone
- (516) 978-8728
- NPI assigned
- Feb 20, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 058726 | NY | Primary |
Addresses
Primary practice location
192 E 75TH St
Keren Etzion C/O Smiles 4 Kids
New York, NY 10021-3242
Mailing address
30 W 63Rd St
Apt 8B
New York, NY 10023-7103
Phone (516) 978-8728
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 |
|---|---|---|---|
| 058726 | NY | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Armonk Pediatric Dentistry | Pediatric Dentistry | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Armonk, NY
- NPI 1457221244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476748800000",
"number": "1770908287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 W 63RD ST",
"address_2": "APT 8B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100237103",
"telephone_number": "516-978-8728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "192 E 75TH ST",
"address_2": "KEREN ETZION C/O SMILES 4 KIDS",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100213242",
"telephone_number": "516-978-8728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETZION",
"first_name": "KEREN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-20",
"last_updated": "2016-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "058726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.