Active NPI
Vicky Evangelidis-Sakellson, DDS
- Dentist
- New York, NY
National Provider Identifier
1831219740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 041266
- Practice address
- 630 W 168TH St
PH 7 Stem
New York, NY 10032-3725 - Phone
- (212) 305-4330
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- 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 | 041266 | NY | Primary |
Addresses
Primary practice location
630 W 168TH St
PH 7 Stem
New York, NY 10032-3725
Mailing address
21 Highland Way
Scarsdale, NY 10583-1609
Phone (212) 305-4330
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 |
|---|---|---|---|---|
| I20160609002376 | NY | Order and Referring Only - Other (Physician) | 2769772334 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831219740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 HIGHLAND WAY",
"city": "SCARSDALE",
"state": "NY",
"postal_code": "105831609",
"telephone_number": "212-305-4330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 W 168TH ST",
"address_2": "PH 7 STEM",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725",
"telephone_number": "212-305-4330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELIDIS-SAKELLSON",
"first_name": "VICKY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "041266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, 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.