Active NPI
Alyssa Marie Wruck, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Wading River, NY
National Provider Identifier
1992142285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 059569-1
- Practice address
- 6336 Ny 25-a, Suite 2
Wading River, NY 11792 - Phone
- (631) 886-3141
- NPI assigned
- May 28, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 059569-1 | NY | Primary |
Addresses
Primary practice location
6336 Ny 25-a, Suite 2
Wading River, NY 11792
Mailing address
6336 Ny 25-a, Suite 2
Wading River, NY 11792
Phone (631) 886-3141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059569-1 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1992142285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6336 NY 25-A, SUITE 2",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "11792",
"telephone_number": "631-886-3141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6336 NY 25-A, SUITE 2",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "11792",
"telephone_number": "631-886-3141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WRUCK",
"first_name": "ALYSSA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-28",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "059569-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wading River, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.