Jack Dwosh, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

25MA04771800 Issued in NJ

Practice address

15000 Midlantic Drive
Suite 100
Mt. Laurel, NJ 08054

Phone

(856) 252-1000

Fax

(856) 252-1100

NPI assigned

Jan 30, 2006

Last updated

Jun 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/uc33702_centerforadvancedurologysalem
• Direct secure messaging: jdwosh10337@njurology.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Jersey Urology LLC

  • Urology Physician
  • Bloomfield, NJ
  • NPI 1588822423
  Medicare reassignment NPD
• Atlantic Lithotripsy

  dba Midatlantic Stone Center

  • Lithotripsy Clinic/Center
  • Marlton, NJ
  • NPI 1245285634
  NPD (past)
• Center for Advanced Urology

  • Urology Physician
  • Salem, NJ
  • NPI 1598720443
  NPD (past)
• Urology Consultants PA

  • Urology Physician
  • Belleville, NJ
  • NPI 1609982099
  NPD (past)

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1033180724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15000 MIDLANTIC DR",
            "address_2": "SUITE 100",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541573",
            "telephone_number": "856-252-1000",
            "fax_number": "856-252-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 MIDLANTIC DRIVE",
            "address_2": "SUITE 100",
            "city": "MT. LAUREL",
            "state": "NJ",
            "postal_code": "08054",
            "telephone_number": "856-252-1000",
            "fax_number": "856-252-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWOSH",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD064953L",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NJ",
            "license": "25MA04771800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0073781000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0055472",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdwosh10337@njurology.direct-ci.com",
            "affiliation": "N",
            "address_1": "15000 Midlantic Drive",
            "address_2": "Suite 100",
            "city": "Mt. Laurel",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "08054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gabrielle Dunning, LPC
• Tara J Dunning
• Durand Academy and Community Services
• Durand, Inc
• Olivia Dutcher, PT, DPT
• Dynamic Commerce Applications, Inc.
• Izabela Kinga Dziedzic
• East Gate Chiropractic & Wellness, LLC
• East Meets West Acupuncture
• Eastern States Pain Specialists Limited

• Urology Physician in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Urology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.