Bryan Jeffrey Penczuk, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02683100 Issued in NJ

Practice address

3822 River Rd Ste 2
Point Pleasant Boro, NJ 08742-2067

Phone

(732) 295-2876

NPI assigned

Aug 3, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

State licenses

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501718400000",
    "number": "1043735764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3822 RIVER RD STE 2",
            "city": "POINT PLEASANT BORO",
            "state": "NJ",
            "postal_code": "087422067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3822 RIVER RD STE 2",
            "city": "POINT PLEASANT BORO",
            "state": "NJ",
            "postal_code": "087422067",
            "telephone_number": "732-295-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCZUK",
        "first_name": "BRYAN",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-03",
        "last_updated": "2017-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02683100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Point Pleasant Boro, NJ
• Providers in Point Pleasant Boro, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.