NPIMap

Organization Active NPI

Concerned Dental Care of Port Jefferson, PLLC

  • General Practice Dentistry
  • Port Jefferson Station, NY
National Provider Identifier
1942562376
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
032077 Issued in NY
Legal business name
CONCERNED DENTAL CARE OF PORT JEFFERSON, PLLC
Practice address
492 Old Town Road
Port Jefferson Station, NY 11776
Phone
(631) 928-1018
NPI assigned
Jun 12, 2012
Last updated
Jun 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Authorized official

Name
Dr. Jay Fensterstock, DDS
Title
President
Phone
(631) 928-1018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 032077 NY Primary

Addresses

Primary practice location

492 Old Town Road
Port Jefferson Station, NY 11776

Mailing address

492 Old Town Road
Port Jefferson Station, NY 11776
Phone (631) 928-1018

National Provider Directory

National Provider Directory

Locations

492 Old Town Rd
Port Jefferson Station, NY 11776
Phone (631) 928-1018

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1942562376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492 OLD TOWN ROAD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-928-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 OLD TOWN ROAD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-928-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCERNED DENTAL CARE OF PORT JEFFERSON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "FENSTERSTOCK",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-928-1018",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "032077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.