Active NPI
Michael Jeffrey Simon, DDS
- Periodontics
- East Orange, NJ
National Provider Identifier
1083620439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DI11071
- Practice address
- 385 Tremont Ave
Dental Service (160)
East Orange, NJ 07018-1023 - Phone
- (973) 676-1000
- Fax
- (973) 395-7019
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DI11071 | NJ | Primary |
Addresses
Primary practice location
385 Tremont Ave
Dental Service (160)
East Orange, NJ 07018-1023
Mailing address
385 Tremont Ave
Dental Service (160)
East Orange, NJ 07018-1023
Phone (973) 676-1000
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 |
|---|---|---|---|
| DI11071 | NJ | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083620439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "385 TREMONT AVE",
"address_2": "DENTAL SERVICE (160)",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070181023",
"telephone_number": "973-676-1000",
"fax_number": "973-395-7019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "385 TREMONT AVE",
"address_2": "DENTAL SERVICE (160)",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070181023",
"telephone_number": "973-676-1000",
"fax_number": "973-395-7019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "MICHAEL",
"middle_name": "JEFFREY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NJ",
"license": "DI11071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.