Individual provider Active NPI

Riyazali Hassam, D.M.D.

  • Dentist
  • Red Bank, NJ
National Provider Identifier
1104913805
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI01982200 Issued in NJ
Practice address
96 W Front St
Red Bank, NJ 07701-1645
Phone
(732) 747-9232
Fax
(732) 747-9234
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI01982200 NJ Primary

Addresses

Primary practice location

96 W Front St
Red Bank, NJ 07701-1645

Mailing address

96 W Front St
Red Bank, NJ 07701-1645
Phone (732) 747-9232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150529000124 NJ Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7810217056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI01982200NJMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104913805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 W FRONT ST",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011645",
            "telephone_number": "732-747-9232",
            "fax_number": "732-747-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 W FRONT ST",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011645",
            "telephone_number": "732-747-9232",
            "fax_number": "732-747-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASSAM",
        "first_name": "RIYAZALI",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01982200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bank, NJ

Sources for this page

Verify at the official NPI Registry.