NPIMap

Organization Active NPI

Modern Orthodontics, PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bronx, NY
National Provider Identifier
1952366973
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
0469571 Issued in NY
Legal business name
MODERN ORTHODONTICS, PC
Practice address
391 E 149TH St RM 214
Bronx, NY 10455-3922
Phone
(718) 993-5454
Fax
(718) 993-5455
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Dr. Kenneth Bruce Cooperman, DMDNPI 1427361872
Title
Owner
Phone
(718) 993-5454

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
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 0469571 NY Primary

Addresses

Primary practice location

391 E 149TH St RM 214
Bronx, NY 10455-3922

Mailing address

391 E 149TH St RM 214
Bronx, NY 10455-3922
Phone (718) 993-5454

Other identifiers 1

IdentifierTypeStateIssuer
200698105MedicaidNY

Other names 1

  • Kenneth Cooperman, DMD, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

355 E 149th St
Rm 202
Bronx, NY 10455
Phone (718) 993-5454

391 E 149th St
Rm 214
Bronx, NY 10455
Phone (718) 665-8300

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1952366973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 E 149TH ST RM 214",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104553922",
            "telephone_number": "718-993-5454",
            "fax_number": "718-993-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 E 149TH ST RM 214",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104553922",
            "telephone_number": "718-993-5454",
            "fax_number": "718-993-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "COOPERMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-993-5454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "0469571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200698105",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenneth Cooperman, DMD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.