NPIMap

Organization Active NPI

Phedryne Robert DDS, PLLC

  • Dentist
  • Valley Stream, NY
National Provider Identifier
1992001093
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
054341-1 Issued in NY
Legal business name
PHEDRYNE ROBERT DDS, PLLC
Practice address
1309 Dutch Broadway
Valley Stream, NY 11580-1534
Phone
(516) 307-1678
NPI assigned
Feb 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Authorized official

Name
Dr. Phedryne Robert, DDS
Title
Dentist
Phone
(516) 307-1678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 054341-1 NY Primary

Addresses

Primary practice location

1309 Dutch Broadway
Valley Stream, NY 11580-1534

Mailing address

1309 Dutch Broadway
Valley Stream, NY 11580-1534
Phone (516) 307-1678

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1992001093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 DUTCH BROADWAY",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801534",
            "telephone_number": "516-307-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 DUTCH BROADWAY",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801534",
            "telephone_number": "516-307-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHEDRYNE ROBERT DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "ROBERT",
        "authorized_official_first_name": "PHEDRYNE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "516-307-1678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "054341-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.