VICTORIA ELENA SHACK (NPI# 1538427802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538427802 |
| Entity Type | Individual |
| Full Name | VICTORIA ELENA SHACK |
| Credential | DDS |
| Practice Address |
150 N Country Rd Apt A10 Port Jefferson NY 11777-2154 |
| Practice Telephone | 9173247927 |
| Mailing Telephone | 9173247927 |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2013-09-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
056759-1 | NY | Dental Providers |
| Street Address |
150 N COUNTRY RD APT A10 |
| City | PORT JEFFERSON |
| State | NY |
| Zip Code | 11777-2154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568088615 | Aqsa Ashraf | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mather Hospital Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-24 |
| 1366068975 | Manal Ahmad | Student in an Organized Health Care Education/Training Program | 75 N County Rd, Level 2 Cmo Suite, Internal Medicine Re, Mather Hospital, Port Jefferson, NY 11777 | 2020-06-19 |
| 1639794555 | Umair Ahmad Ansari | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mother Hospital, Internal Medicine Re, Level 2 - Cmd Suite, Port Jefferson, NY 11777 | 2020-06-16 |
| 1578188132 | Manasi Sule | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Mather Hospital, Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-10 |
| 1508480716 | Imona Subedi | Student in an Organized Health Care Education/Training Program | 75 N Country Road, Level 2 - Cmo Suite, Mather Hospital Internal Medicine Residency Program, Port Jefferson, NY 11777 | 2020-06-03 |
| 1184252108 | Romana Imtiaz Syed | Student in an Organized Health Care Education/Training Program | Liza M Dominioni,mather Hospital,internal Medicine, Residency Program,level 2-cmo Suite,75 N Country Rd, Port Jefferson, NY 11777 | 2020-03-27 |
| 1649807348 | Mustafa Mohammed Abdulsada | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Ny, Level 2 - Cmo Suite, Port Jefferson, NY 11777 | 2020-03-24 |
| 1184264764 | Girma Moges Gamme | Surgery | 625 Belle Terre Rd, Suite 203 Mather Hospital, Port Jefferson, NY 11777 | 2020-01-10 |
| 1811554637 | Kausar Ali | Nurse Practitioner | 408 Thompson Street, Port Jefferson, NY 11777 | 2019-05-28 |
| 1073097531 | Ministry for Hope, Inc. Montfort Therapeutic Residence | Residential Treatment Facility, Physical Disabilities | 100 Stonyhill Road, Port Jefferson, NY 11777 | 2018-09-20 |
| Find all providers in zip 11777 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992171441 | Franklin E. Peterson Dds | Dentist | 111 N Country Rd, Port Jefferson, NY 11777-2605 | 2015-08-19 |
| 1134595580 | Sara Grace | Dentist | 111 N Country Rd Ste 1, Port Jefferson, NY 11777-2605 | 2015-08-19 |
| 1194863134 | Leonard Thomas Fazio | Dentist | 1303 Main St, The Pen and Pencil Building Suite 2, Port Jefferson, NY 11777-2257 | 2007-02-02 |
| 1104919463 | Gregory Thaddeus St Clair | Dentist | 101 Hoyt Ln, Port Jefferson, NY 11777-1318 | 2006-10-01 |
| 1407858517 | Carl Peter Palmblad | Dentist | 14 N Country Rd, Port Jefferson, NY 11777-2116 | 2005-06-01 |
| 1548573165 | Jennifer Englebright | Dentist | 656 Main St, Port Jefferson, NY 11777-2203 | 2010-07-24 |
| 1417260167 | Dr. Lauren S. Argentina, Dds, PC | Dentist | 714 Main St, Port Jefferson, NY 11777-2223 | 2010-07-23 |
| 1093960890 | Port Jefferson Dental Group P. C. | Dentist | 602 Main St, Port Jefferson, NY 11777-2203 | 2008-11-20 |
| 1154518215 | John Michael Perlman | Dentist | 101 Hoyt Ln, Port Jefferson, NY 11777-1318 | 2007-10-02 |
| 1013131499 | Christopher William Oglesby | Dentist | 656 Main St, Port Jefferson, NY 11777-2203 | 2007-04-13 |
| Find all providers in PORT JEFFERSON | ||||
| City | PORT JEFFERSON |
| Zip Code | 11777 |
Please comment or provide details below to improve the information on VICTORIA ELENA SHACK.
| 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.