NPIMap

Organization Active NPI

Decker,Sbuttoni,Boghosian,Dicerbo Specialists in Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Albany, NY
National Provider Identifier
1831229418
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
0299761 Issued in NY
Legal business name
DECKER,SBUTTONI,BOGHOSIAN,DICERBO SPECIALISTS IN ORTHODONTICS
Practice address
1004 Western Ave
Albany, NY 12203-2743
Phone
(518) 489-8377
Fax
(518) 489-8462
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. A. Thomas Decker, D.M.D.
Title
President
Phone
(518) 489-8377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 0299761 NY Primary

Addresses

Primary practice location

1004 Western Ave
Albany, NY 12203-2743

Mailing address

1004 Western Ave
Albany, NY 12203-2743
Phone (518) 489-8377

Other identifiers 1

IdentifierTypeStateIssuer
00555151MedicaidNY

National Provider Directory

National Provider Directory

Locations

1004 Western Ave
Albany, NY 12203
Phone (518) 489-8377

Practitioners & affiliated clinicians

Practitioners 6

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831229418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032743",
            "telephone_number": "518-489-8377",
            "fax_number": "518-489-8462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032743",
            "telephone_number": "518-489-8377",
            "fax_number": "518-489-8462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKER,SBUTTONI,BOGHOSIAN,DICERBO SPECIALISTS IN ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "A.",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-489-8377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "0299761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00555151",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.