Individual provider Active NPI

Jiffry Kolonda, DMD

  • Dentist
  • Brooklyn, NY
National Provider Identifier
1821593179
Registry record updated Mar 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
060574 Issued in NY
Practice address
5800 3Rd Ave Ste E
Brooklyn, NY 11220-3702
Phone
(314) 283-0838
NPI assigned
Mar 28, 2018
Last updated
Mar 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 060574 NY Primary

Addresses

Primary practice location

5800 3Rd Ave Ste E
Brooklyn, NY 11220-3702

Mailing address

23 Clinton St Apt 3C
New York, NY 10002-1722
Phone (314) 283-0838

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

LicenseStateTypeSpecialty
060574NYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1821593179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 CLINTON ST APT 3C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100021722",
            "telephone_number": "314-283-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 3RD AVE STE E",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203702",
            "telephone_number": "314-283-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLONDA",
        "first_name": "JIFFRY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "060574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.