Individual provider Active NPI

John William Rosenlieb Jr., DMD

  • Dentist
  • West Hartford, CT
National Provider Identifier
1114001609
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7185 Issued in CT
Practice address
928 Farmington Ave
West Hartford, CT 06107-2227
Phone
(860) 233-7514
NPI assigned
Oct 24, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

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 7185 CT Primary

Addresses

Primary practice location

928 Farmington Ave
West Hartford, CT 06107-2227

Mailing address

928 Farmington Ave
West Hartford, CT 06107-2227
Phone (860) 233-7514

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20150313002278 CT Order and Referring Only - DentistPractitioner - Dentist 5092031872

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114001609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072227",
            "telephone_number": "860-233-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072227",
            "telephone_number": "860-233-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENLIEB",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "7185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.