Active NPI
Pedro Mateo, D.D.S.
- Dentist
- Brooklyn, NY
National Provider Identifier
1871658815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 048862
- Practice address
- 3910 5TH Ave
Brooklyn, NY 11232-2926 - Phone
- (718) 851-3600
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 048862 | NY | Primary |
Addresses
Primary practice location
3910 5TH Ave
Brooklyn, NY 11232-2926
Mailing address
3910 5TH Ave
Brooklyn, NY 11232-2926
Phone (718) 851-3600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02395444 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048862 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871658815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3910 5TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112322926",
"telephone_number": "718-851-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3910 5TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112322926",
"telephone_number": "718-851-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATEO",
"first_name": "PEDRO",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "048862",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02395444",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.