NPIMap

Organization Active NPI

Citidental of Woodhaven PC

  • Dentist
  • Ozone Park, NY
National Provider Identifier
1811276926
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
052174 Issued in NY
Legal business name
CITIDENTAL OF WOODHAVEN PC
Practice address
10149 Woodhaven Blvd
Suite 2
Ozone Park, NY 11416-2300
Phone
(718) 848-7722
NPI assigned
Aug 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marina Shraga, DDSNPI 1023227642
Title
President
Phone
(917) 797-7272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 052174 NY Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 055124 NY

Addresses

Primary practice location

10149 Woodhaven Blvd
Suite 2
Ozone Park, NY 11416-2300

Mailing address

10149 Woodhaven Blvd
Suite 2
Ozone Park, NY 11416-2300
Phone (718) 848-7722

Other identifiers 2

IdentifierTypeStateIssuer
03307031MedicaidNY
02721117MedicaidNY

Other names 1

  • CitiDental Other name

National Provider Directory

National Provider Directory

Locations

10149 Woodhaven Blvd
Ste 2
Ozone Park, NY 11416
Phone (718) 848-7722

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1312588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1811276926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10149 WOODHAVEN BLVD",
            "address_2": "SUITE 2",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162300",
            "telephone_number": "718-848-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10149 WOODHAVEN BLVD",
            "address_2": "SUITE 2",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162300",
            "telephone_number": "718-848-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIDENTAL OF WOODHAVEN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-06",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "SHRAGA",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-797-7272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "052174",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "055124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03307031",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02721117",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CitiDental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ozone Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.