Active NPI
Robert Costisevschi
- Pediatric Dentistry
- Bronx, NY
National Provider Identifier
1831534510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 100501
- Practice address
- 4422 3Rd Ave
Bronx, NY 10457-2545 - Phone
- (718) 960-9000
- NPI assigned
- May 7, 2013
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 100501 | CA | Primary |
Addresses
Primary practice location
4422 3Rd Ave
Bronx, NY 10457-2545
Mailing address
313 Warwick Dr
Walnut Creek, CA 94598-4134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20170112001482 | CA | Order and Referring Only - Other (Physician) | 6406138106 |
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": "1367884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478649600000",
"number": "1831534510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 WARWICK DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945984134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4422 3RD AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104572545",
"telephone_number": "718-960-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTISEVSCHI",
"first_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-07",
"last_updated": "2016-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "100501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.