Active NPI
Gennadiy Simonovskiy
- Dentist
- Brooklyn, NY
National Provider Identifier
1992842678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 048396
- Practice address
- 1203 Avenue J
Suite 4a
Brooklyn, NY 11230-3669 - Phone
- (718) 513-3520
- Fax
- (718) 252-5070
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 048396 | NY | Primary |
Addresses
Primary practice location
1203 Avenue J
Suite 4a
Brooklyn, NY 11230-3669
Mailing address
1203 Avenue J
Suite 4a
Brooklyn, NY 11230-3669
Phone (718) 513-3520
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 |
|---|---|---|---|
| 048396 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381881600000",
"number": "1992842678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 AVENUE J",
"address_2": "SUITE 4A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112303669",
"telephone_number": "718-513-3520",
"fax_number": "718-252-5070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 AVENUE J",
"address_2": "SUITE 4A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112303669",
"telephone_number": "718-513-3520",
"fax_number": "718-252-5070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONOVSKIY",
"first_name": "GENNADIY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2013-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "048396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.