Mitchell L Elias, DDS – Dentist in Pine Brook, NJ

Key facts

NPI: 1124447065
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: NJ9682 (NJ)
Practice address: 147 Konner Ave
Pine Brook, NJ 07058-9436
Phone: (973) 575-4700
NPI assigned: Apr 8, 2014
Sex: Male
Sole proprietor: Yes

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.

Mitchell L. Elias, DDS Dentist · Pine Brook, NJ · NPI 1629281928

NPD (past) Authorized official DENTIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
NJ9682	NJ	MD	Dentist

Practice roles

Organization	Specialty	Status	New patients
Mitchell L. Elias, DDS	Dentist	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	NJ9682	NJ	Yes
Dentist	122300000X	030368	NY

Addresses

Primary practice location

147 Konner Ave
Pine Brook, NJ 07058-9436

Mailing address

147 Konner Ave
Pine Brook, NJ 07058-9436
Phone (973) 575-4700

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 8, 2014.

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396915200000",
    "number": "1124447065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 KONNER AVE",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589436",
            "telephone_number": "973-575-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 KONNER AVE",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589436",
            "telephone_number": "973-575-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIAS",
        "first_name": "MITCHELL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-08",
        "last_updated": "2014-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "NJ9682",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "030368",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Brook, NJ

All providers in Pine Brook, NJ · Dentist in New Jersey

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.