Individual provider Active NPI

Eddy A Ferreira, DDS

  • General Practice Dentistry
  • Jackson Heights, NY
National Provider Identifier
1972592012
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043295 Issued in NY
Practice address
3564 79TH St
Jackson Heights, NY 11372-4817
Phone
(718) 478-4242
Fax
(718) 478-4475
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 043295 NY Primary

Addresses

Primary practice location

3564 79TH St
Jackson Heights, NY 11372-4817

Mailing address

3564 79TH St
Jackson Heights, NY 11372-4817
Phone (718) 478-4242

Other identifiers 2

IdentifierTypeStateIssuer
01226140MedicaidNY
0008223OtherNYDORAL PROVIDER #

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150825003598 NY Order and Referring Only - Other (Non-Physician) 6103132949

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
043295NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1972592012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3564 79TH ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113724817",
            "telephone_number": "718-478-4242",
            "fax_number": "718-478-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3564 79TH ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113724817",
            "telephone_number": "718-478-4242",
            "fax_number": "718-478-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERREIRA",
        "first_name": "EDDY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01226140",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL PROVIDER #",
            "identifier": "0008223",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.