Active NPI
Rajeshwerrao Kokkirala, D.D.S
- General Practice Dentistry
- Bronx, NY
National Provider Identifier
1790867646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 037203
- Practice address
- 1418 Wythe Place
Ground Floor
Bronx, NY 10452 - Phone
- (718) 681-8901
- NPI assigned
- Oct 19, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 037203 | NY | Primary |
Addresses
Primary practice location
1418 Wythe Place
Ground Floor
Bronx, NY 10452
Mailing address
115 N Harrison Ave
Congers, NY 10920-1900
Phone (718) 681-8901
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 |
|---|---|---|---|---|
| I20160114000453 | NY | Order and Referring Only - Dentist | 7719280304 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037203 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Firo Inc | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790867646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 N HARRISON AVE",
"city": "CONGERS",
"state": "NY",
"postal_code": "109201900",
"telephone_number": "718-681-8901",
"fax_number": "718-681-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1418 WYTHE PLACE",
"address_2": "GROUND FLOOR",
"city": "BRONX",
"state": "NY",
"postal_code": "10452",
"telephone_number": "718-681-8901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOKKIRALA",
"first_name": "RAJESHWERRAO",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "037203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bronx, NY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.