J.S. Atlantic Dental P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047193 Issued in NY

Legal business name

J.S. ATLANTIC DENTAL P.C.

Practice address

1637 East 17TH St. 2ND Floor
J.S. Atlantic Dental P.C.
Brooklyn, NY 11229-7035

Phone

(718) 339-0627

Fax

(718) 339-0466

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Joseph Gregory Shyknevsky, D.D.S.

Title

President

Phone

(718) 339-0627

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851427199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 297035",
            "address_2": "J.S. ATLANTIC DENTAL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112297035",
            "telephone_number": "718-339-0627",
            "fax_number": "718-339-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1637 EAST 17TH ST. 2ND FLOOR",
            "address_2": "J.S. ATLANTIC DENTAL P.C.",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112297035",
            "telephone_number": "718-339-0627",
            "fax_number": "718-339-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J.S. ATLANTIC DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHYKNEVSKY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-339-0627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01804791",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.