Santa Locascio, D.D.S.
Individual provider Active NPI Dentist · Ridgewood, NY
NPI 1801112495 · NPPES record last updated Apr 8, 2010
Key facts
- NPI
- 1801112495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 042722 (NY)
- Practice address
- 7016 Fresh Pond Rd
Ridgewood, NY 11385-5902 - Phone
- (718) 628-6588
- NPI assigned
- Apr 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150629000323 | NY | Practitioner - Dentist |
0648582080 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Santa Locascio DDS PC | Dentist | Current |
Accepting new patients |
Locations
7016 Fresh Pond Rd
Ridgewood, NY 11385
Phone (718) 628-6588
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 042722 | NY | Yes |
Addresses
Primary practice location
7016 Fresh Pond Rd
Ridgewood, NY 11385-5902
Mailing address
7016 Fresh Pond Rd
Ridgewood, NY 11385-5902
Phone (718) 628-6588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01197731 | Medicaid | NY |
Other providers in Ridgewood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.