Nicole M Ptak-Yenchman, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

0552731 Issued in NY

Practice address

2200 Northern Blvd
Suite 107
Greenvale, NY 11548

Phone

(516) 621-6100

Fax

(516) 621-6101

NPI assigned

Jul 23, 2009

Last updated

May 6, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Nicole M Ptak Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Hills Dentistry, PLLC

  • General Practice Dentistry
  • Greenvale, NY
  • NPI 1013314640
  NPD (past)

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1952531931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NORTHERN BLVD",
            "address_2": "SUITE 107",
            "city": "GREENVALE",
            "state": "NY",
            "postal_code": "11548",
            "telephone_number": "516-621-6100",
            "fax_number": "516-621-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NORTHERN BLVD",
            "address_2": "SUITE 107",
            "city": "GREENVALE",
            "state": "NY",
            "postal_code": "11548",
            "telephone_number": "516-621-6100",
            "fax_number": "516-621-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PTAK-YENCHMAN",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-23",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0552731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "PTAK",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Ari Popowich, MD
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• Proneurodiagnostics (ProDiagnostics)
• Propel Physical Therapy PC
• Punam Prabhakar MD PC
• Purecare Pharmacy and Wellness Inc
• Purecare Pharmacy and Wellness Inc
• Daniella Pusateri, ATC
• Erin Mary Pyatt, FNP

• Dentist in Greenvale, NY
• Providers in Greenvale, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; 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.

Verify at the official NPI Registry.