Individual provider Active NPI

Raymond Mascolo, DDS

  • General Practice Dentistry
  • Islip, NY
National Provider Identifier
1982798039
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043347 Issued in NY
Practice address
242 Main St
Islip, NY 11751-3415
Phone
(631) 224-7660
Fax
(631) 859-1862
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 043347 NY Primary

Addresses

Primary practice location

242 Main St
Islip, NY 11751-3415

Mailing address

242 Main St
Islip, NY 11751-3415
Phone (631) 224-7660

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150608002618 NY Order and Referring Only - DentistPractitioner - Dentist 1052632650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
043347NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982798039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513415",
            "telephone_number": "631-224-7660",
            "fax_number": "631-859-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513415",
            "telephone_number": "631-224-7660",
            "fax_number": "631-859-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASCOLO",
        "first_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip, NY

Sources for this page

Verify at the official NPI Registry.