Active NPI
Julia Mayzenberg, DMD
- Pediatric Dentistry
- Philadelphia, PA
National Provider Identifier
1063609824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS035665
- Practice address
- 240 Geiger Rd
Philadelphia, PA 19115-1008 - Phone
- (215) 464-2411
- Fax
- (215) 969-0215
- NPI assigned
- Sep 26, 2007
- Last updated
- Sep 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS035665 | PA | Primary |
Addresses
Primary practice location
240 Geiger Rd
Philadelphia, PA 19115-1008
Mailing address
240 Geiger Rd
Philadelphia, PA 19115-1008
Phone (215) 464-2411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS035665 | PA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190764800000",
"number": "1063609824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 GEIGER RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191151008",
"telephone_number": "215-464-2411",
"fax_number": "215-969-0215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 GEIGER RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191151008",
"telephone_number": "215-464-2411",
"fax_number": "215-969-0215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYZENBERG",
"first_name": "JULIA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-26",
"last_updated": "2007-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS035665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.