Jack Miceli, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39067 Issued in NY

Practice address

255 Mason Ave.
Staten Island, NY 10305-3416

Phone

(718) 987-6543

Fax

(718) 987-6542

NPI assigned

Jan 2, 2007

Last updated

Feb 23, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jack Miceli DDS PC

  dba Marine Dental Services

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1932266566
  NPD (past) Authorized official
• JDS Dental Care PLLC

  dba Marine Dental Services

  • Dentist
  • Staten Island, NY
  • NPI 1922640630
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1851458483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 MASON AVE.",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053416",
            "telephone_number": "718-987-6543",
            "fax_number": "718-987-6542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 MASON AVE.",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053416",
            "telephone_number": "718-987-6543",
            "fax_number": "718-987-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "JACK",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "39067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02241885",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raza Mian, CRNA
• Brooke Miano, OTR/L
• Lindsay Miarmi, PH.D.
• Rachel Mica, RN
• Tonianne Marie Micara, MS ED
• Mary A Miceli, LCSW
• Peter Joseph Miceli, M.D.
• Michael B. Kushner DDS PC (Forest Dental)
• Michael Castania (Elite Mobility & Physical Therapy)
• Michael Costes, MD

• General Practice Dentistry in Staten Island, NY
• Providers in Staten Island, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; 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.