Active NPI
Michael Nicholas Koumas, D.D.S.
- Dentist
- Newburgh, NY
National Provider Identifier
1962507970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 049088
- Practice address
- 4 HDSN Vly Prof PLZ
Newburgh, NY 12550-3101 - Phone
- (845) 562-1108
- Fax
- (845) 569-1964
- NPI assigned
- Sep 14, 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 | 049088 | NY | Primary |
Addresses
Primary practice location
4 HDSN Vly Prof PLZ
Newburgh, NY 12550-3101
Mailing address
4 HDSN Vly Prof PLZ
Newburgh, NY 12550-3101
Phone (845) 562-1108
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150319001271 | NY | Order and Referring Only - Other (Physician) | 8022335645 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049088 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962507970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 HDSN VLY PROF PLZ",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "125503101",
"telephone_number": "845-562-1108",
"fax_number": "845-569-1964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 HDSN VLY PROF PLZ",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "125503101",
"telephone_number": "845-562-1108",
"fax_number": "845-569-1964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUMAS",
"first_name": "MICHAEL",
"middle_name": "NICHOLAS",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "049088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.