NPIMap

Organization Active NPI

John G Poulos DDS

  • Prosthodontics
  • Northport, NY
National Provider Identifier
1932597606
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
31347 Issued in NY
Legal business name
JOHN G POULOS DDS
Practice address
22 Laurel Ave
Northport, NY 11768-3165
Phone
(631) 262-0644
Fax
(631) 262-0645
NPI assigned
Jan 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Authorized official

Name
Dr. John G Poulos, DDSNPI 1871007773
Title
Owner
Phone
(631) 262-0644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0700X 31347 NY Primary

Addresses

Primary practice location

22 Laurel Ave
Northport, NY 11768-3165

Mailing address

22 Laurel Ave
Northport, NY 11768-3165
Phone (631) 262-0644

National Provider Directory

National Provider Directory

Locations

22 Laurel Ave
Northport, NY 11768
Phone (631) 262-0644

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1932597606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 LAUREL AVE",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683165",
            "telephone_number": "631-262-0644",
            "fax_number": "631-262-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 LAUREL AVE",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683165",
            "telephone_number": "631-262-0644",
            "fax_number": "631-262-0645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN G POULOS DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "POULOS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-262-0644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "31347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; 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.