Active NPI
Kelly Mastrovito, DDS
- Pediatric Dentistry
- Garden City, NY
National Provider Identifier
1871059113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 062043-01
- Practice address
- 585 Stewart Ave Ste LL60
Garden City, NY 11530-4786 - Phone
- (516) 222-5100
- NPI assigned
- Feb 12, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 062043-01 | NY | Primary |
Addresses
Primary practice location
585 Stewart Ave Ste LL60
Garden City, NY 11530-4786
Mailing address
305 Henry St Apt 3R
Brooklyn, NY 11201-5567
Phone (845) 608-3114
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 |
|---|---|---|---|---|
| I20190820001705 | NY | Order and Referring Only - Dentist | 0042548794 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062043-01 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765843200000",
"number": "1871059113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 HENRY ST APT 3R",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015567",
"telephone_number": "845-608-3114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "585 STEWART AVE STE LL60",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115304786",
"telephone_number": "516-222-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASTROVITO",
"first_name": "KELLY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-12",
"last_updated": "2025-12-16",
"certification_date": "2025-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "062043-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.