LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C. (NPI# 1043417991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043417991 |
| Entity Type | Organization |
| Organization Name | LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C. |
| Practice Address |
1300 Union Tpke Suite 201 New Hyde Park NY 11040-1759 |
| Practice Telephone | 5167753737 |
| Practice Fax Number | 5167753736 |
| Mailing Telephone | 5167753737 |
| Mailing Fax Number | 5167753736 |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2016-07-13 |
| Authorized Official Name | DR. MICHAEL SHRECK (PRESIDENT) |
| Authorized Official Telephone | 5167753737 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
039925 | NY | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C. | 1300 Union Tpke, Suite 201, New Hyde Park, Ny 11561 |
| Street Address |
1300 UNION TPKE SUITE 201 |
| City | NEW HYDE PARK |
| State | NY |
| Zip Code | 11040-1759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124029434 | Charles Bruno | Obstetrics & Gynecology | 1300 Union Tpke, New Hyde Park, NY 11040-1759 | 2005-08-09 |
| 1699215335 | Mental Health Counseling Wellness Services Pllc | Counselor | 1300 Union Tpke, Suite 308, New Hyde Park, NY 11040-1764 | 2017-02-28 |
| 1891180212 | Fabiola Milord, Dds, Mph, Pllc | Preferred Provider Organization | 1300 Union Tpke, Suite 101, New Hyde Park, NY 11040-1764 | 2015-04-02 |
| 1992103352 | Precision Pain Care and Rehabilitation P.C. | Pain Medicine | 1300 Union Tpke, Suite 203, New Hyde Park, NY 11040-1764 | 2014-12-16 |
| 1194035584 | D.k. Held, M.d., P.C. | Surgery | 1300 Union Tpke, New Hyde Park, NY 11040-1759 | 2010-10-19 |
| 1679897631 | Frank A Evanov Md PC | Internal Medicine | 1300 Union Tpke, New Hyde Park, NY 11040-1759 | 2010-03-19 |
| 1962733782 | Ruthie Rapaport Anfang | Audiologist | 1300 Union Tpke, 103a, New Hyde Park, NY 11040-1759 | 2010-01-18 |
| 1669701512 | Samuel Fox Medical Doctor PC | Anesthesiology | 1300 Union Tpke, New Hyde Park, NY 11040-1759 | 2009-12-23 |
| 1417282658 | Joseph Fierstein Md PC | Internal Medicine | 1300 Union Tpke, Suite 305, New Hyde Park, NY 11040-1759 | 2009-10-06 |
| 1154555407 | Sujata Prasad | Dentist | 1300 Union Tpke, Suite - 106, New Hyde Park, NY 11040 | 2009-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366734 | Naurin Shaki | Case Management | 108 Bryant Ave, New Hyde Park, NY 11040 | 2020-11-04 |
| 1326645920 | Oksana Isakharov | Marriage & Family Therapist | Remote Telehealth Due To Pandemic, Remote Telehealth Due To Pandemic, NY 11040 | 2020-10-06 |
| 1639784036 | Michelle Edith Narain | Nurse Practitioner | 270-05 76th Aveune, New Hyde Park, NY 11040 | 2020-09-11 |
| 1124636188 | Shannon Maureen O'connell | Physician Assistant | 270-05 270th Ave, New Hyde Park, NY 11040 | 2020-07-16 |
| 1851929384 | Hollie Brown | Student in an Organized Health Care Education/Training Program | 45 Lakeville Rd Ste M41, New Hyde Park, NY 11040 | 2020-03-30 |
| 1780211797 | Miriam Tarrash | Student in an Organized Health Care Education/Training Program | Lijmc, 270-05 76th Avenue, New Hyde Park, NY 11040 | 2020-03-27 |
| 1902438971 | Kristina Petrich | Student in an Organized Health Care Education/Training Program | Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 | 2020-02-07 |
| 1528622735 | David Olatunji Omole | Dentist | 270-05 76th Avenue Dept. of Dental Medicine / Oral And, Surgery New Hyde Park, Ny, Ny 11040, New Hyde Park, NY 11040 | 2019-04-24 |
| 1720642093 | Thanzina Chowdhury | Pharmacy | 271-11 76th Ave, Queens, NY 11040 | 2019-04-23 |
| 1427519834 | Connor William Crowley | Student in an Organized Health Care Education/Training Program | Office of Surgical Education Victoria M. Waithe, 270-05 76th Avenue. Research Bldg - C Level Room 039ab, New Hyde Park, NY 11040 | 2019-03-28 |
| Find all providers in zip 11040 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679753669 | North Shore Periodontics, PC | Dentist | 2001 Marcus Ave Ste E244, Suite E244, New Hyde Park, NY 11042-1011 | 2007-11-07 |
| 1992358311 | Allie Luxenberg | Dentist | 700 Hillside Ave, New Hyde Park, NY 11040-2531 | 2019-07-24 |
| 1942407895 | Michael Stuart Shreck | Dentist | 1300 Union Tpke, New Hyde Park, NY 11040-1759 | 2007-07-02 |
| 1649320466 | Harvey W. Glicker,dds,pc | Dentist | 700 Hillside Ave, New Hyde Park, NY 11040-2513 | 2007-01-12 |
| 1114077989 | Harvey Glicker | Dentist | 700 Hillside Ave, New Hyde Park, NY 11040-2513 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467052068 | Tamar Friling | Dentist | 247 3rd Ave Rm 203, New York, NY 10010-7453 | 2020-11-01 |
| 1851901896 | Kristen Brocavich | Dentist | 150 Islip Ave Ste 11, Islip, NY 11751-3222 | 2020-08-04 |
| 1962056499 | Zahavi Dental of Rochester | Dentist | 1815 S. Clinton Ave, 510, Rocheter, NY 14618 | 2019-08-01 |
| 1346710241 | Bedford Hills Dental P.C. | Dentist | 3 Depot Plz, Bedford Hills, NY 10507-1807 | 2018-12-04 |
| 1093295735 | Giffords Dental, P.C. | Dentist | 79 Giffords Ln, Staten Island, NY 10308-2411 | 2018-08-21 |
| 1215416805 | Alex Zusin | Dentist | 2540 Batchelder St Apt 5o, Brooklyn, NY 11235-1530 | 2018-08-14 |
| 1639655764 | Kiss Dental Care Pllc | Dentist | 425 Robinson Ave Ste 4, Newburgh, NY 12550-3303 | 2018-07-11 |
| 1689189524 | Mid Island Dental Specialists, PC | Dentist | 400 S Oyster Bay Rd Ste 201, Hicksville, NY 11801-3500 | 2017-12-13 |
| 1477068906 | Mohammad Reshad | Dentist | 230 Riverside Dr Apt 10m, New York, NY 10025-6192 | 2017-12-06 |
| 1043724479 | Ioana Chesnoiu Matei | Dentist | 630 W 168th St Rm 7-200c, New York, NY 10032-3725 | 2017-11-21 |
| Find all providers with the same taxonomy | ||||
| City | NEW HYDE PARK |
| Zip Code | 11040 |
Please comment or provide details below to improve the information on LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.