Active NPI
Tatyana Lysenko
- Dentist
- Mount Laurel, NJ
National Provider Identifier
1093056194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI01901700
- Practice address
- 3201 Route 38
Suite 102
Mount Laurel, NJ 08054-9721 - Phone
- (856) 722-0333
- Fax
- (856) 437-6101
- NPI assigned
- Mar 14, 2013
- 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 | 22DI01901700 | NJ | Primary |
Addresses
Primary practice location
3201 Route 38
Suite 102
Mount Laurel, NJ 08054-9721
Mailing address
3201 Route 38
Suite 102
Mount Laurel, NJ 08054-9721
Phone (856) 722-0333
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 |
|---|---|---|---|
| 22DI01901700 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile America PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Mt Laurel, NJ
- NPI 1437121399
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443398400000",
"number": "1093056194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 ROUTE 38",
"address_2": "SUITE 102",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080549721",
"telephone_number": "856-722-0333",
"fax_number": "856-437-6101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 ROUTE 38",
"address_2": "SUITE 102",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080549721",
"telephone_number": "856-722-0333",
"fax_number": "856-437-6101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSENKO",
"first_name": "TATYANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-14",
"last_updated": "2015-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI01901700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Laurel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.