Active NPI
Paul J Masuicca, DDS
- Dentist
- Phoenix, NY
National Provider Identifier
1831173194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 35073
- Practice address
- 218 Cty Rd 57
Phoenix, NY 13135 - Phone
- (315) 695-2128
- Fax
- (315) 695-5678
- NPI assigned
- Dec 1, 2005
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 35073 | NY | Primary |
Addresses
Primary practice location
218 Cty Rd 57
Phoenix, NY 13135
Mailing address
219 County Route 57
Phoenix, NY 13135
Phone (315) 695-2128
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
| License | State | Type | Specialty |
|---|---|---|---|
| 35073 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831173194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 COUNTY ROUTE 57",
"city": "PHOENIX",
"state": "NY",
"postal_code": "13135",
"telephone_number": "315-695-2128",
"fax_number": "315-695-5678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 CTY RD 57",
"city": "PHOENIX",
"state": "NY",
"postal_code": "13135",
"telephone_number": "315-695-2128",
"fax_number": "315-695-5678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASUICCA",
"first_name": "PAUL",
"middle_name": "J",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "35073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.