Javoncia Betty

Key facts

NPI

1043952609

Entity type

Individual (NPI type 1)

Primary specialty

Other Specialist/Technologist 246Z00000X

Practice address

700 US Highway 46 Ste 420
Fairfield, NJ 07004-1532

Phone

(973) 882-3456

NPI assigned

Apr 12, 2022

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 12, 2022.

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1043952609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 US HIGHWAY 46 STE 420",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070041532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 US HIGHWAY 46 STE 420",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070041532",
            "telephone_number": "973-882-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTY",
        "first_name": "JAVONCIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Fairfield, NJ · Other Specialist/Technologist in New Jersey