Michael V Bleyzer, DDS
Individual provider Active NPI Dentist · Pomona, NY
NPI 1962834804 · NPPES record last updated Aug 2, 2013
Key facts
- NPI
- 1962834804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 42709 (NY)
- Practice address
- 14 Thiells Mount Ivy Rd
Pomona, NY 10970-3021 - Phone
- (845) 429-8060
- Fax
- (845) 429-3570
- NPI assigned
- Aug 2, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230426002820 | NY | Order and Referring Only - Dentist |
0042675068 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42709 | NY | MD | Dentist |
| 042709 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 42709 | NY | Yes |
Addresses
Primary practice location
14 Thiells Mount Ivy Rd
Pomona, NY 10970-3021
Mailing address
14 Thiells Mt. Ivy Rd.
Pomona, NY 10970
Phone (845) 429-8060
Other providers in Pomona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.