Active NPI
Marcus D Johnson, DDS, MSD
- Endodontics
- Garden City, NY
National Provider Identifier
1790067874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 055305
- Practice address
- 1103 Stewart Ave FL 1
Garden City, NY 11530-4859 - Phone
- (516) 222-1822
- Fax
- (516) 227-5361
- NPI assigned
- Sep 14, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 055305 | NY | Primary |
Addresses
Primary practice location
1103 Stewart Ave FL 1
Garden City, NY 11530-4859
Mailing address
30 E 40TH St
RM 1004
New York, NY 10016-1208
Phone (212) 725-2573
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160415001141 | NY | Order and Referring Only - Other (Physician) | 4688972110 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055305 | NY | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457481600000",
"number": "1790067874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 E 40TH ST",
"address_2": "RM 1004",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100161208",
"telephone_number": "212-725-2573",
"fax_number": "212-725-2574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 STEWART AVE FL 1",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115304859",
"telephone_number": "516-222-1822",
"fax_number": "516-227-5361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARCUS",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-14",
"last_updated": "2016-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "055305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.