Jonathan Fan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02429200 Issued in NJ

Practice address

108 Village Center Dr FL 2
Freehold, NJ 07728-2510

Phone

(732) 780-2100

Fax

(732) 879-0255

NPI assigned

Jul 2, 2009

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1033348776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 VILLAGE CENTER DR FL 2",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282510",
            "telephone_number": "732-780-2100",
            "fax_number": "732-879-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 VILLAGE CENTER DR FL 2",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282510",
            "telephone_number": "732-780-2100",
            "fax_number": "732-879-0255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "398 Vassar Dr",
            "address_purpose": "LOCATION",
            "city": "Freehold",
            "state": "NJ",
            "postal_code": "077285360",
            "country_code": "US",
            "telephone_number": "908-415-8782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02429200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Familee, Inc.
• Families Together Counseling Services
• Family and Cosmetic Dentistry,DRS. Stanislaus and Michelotti
• Family Care MD LLC
• Family Dermatology of New Jersey PC
• Amanda Fanara
• Evelyn Fano, OTR
• Lauren Farnsworth, LAC
• Chelsea Farrar
• Ashley Lynn Fava, FNP-C

• General Practice Dentistry in Freehold, NJ
• Providers in Freehold, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; 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.