Active NPI
Raysa M Martin, DDS
- Dentist
- Wyckoff, NJ
National Provider Identifier
1073023560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DI02691900
- Practice address
- 800 Wyckoff Ave Ste 101
Wyckoff, NJ 07481-1525 - Phone
- (201) 891-4425
- Fax
- (201) 891-7926
- NPI assigned
- Oct 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DI02691900 | NJ | Primary |
Addresses
Primary practice location
800 Wyckoff Ave Ste 101
Wyckoff, NJ 07481-1525
Mailing address
800 Wyckoff Ave Ste 101
Wyckoff, NJ 07481-1525
Phone (201) 891-4425
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 |
|---|---|---|---|
| DI02691900 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628553600000",
"number": "1073023560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 WYCKOFF AVE STE 101",
"city": "WYCKOFF",
"state": "NJ",
"postal_code": "074811525",
"telephone_number": "201-891-4425",
"fax_number": "201-891-7926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 WYCKOFF AVE STE 101",
"city": "WYCKOFF",
"state": "NJ",
"postal_code": "074811525",
"telephone_number": "201-891-4425",
"fax_number": "201-891-7926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "RAYSA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-10",
"last_updated": "2021-08-10",
"certification_date": "2021-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "DI02691900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyckoff, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.