NPIMap

Organization Active NPI

Avenue U Orthodontics, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Brooklyn, NY
National Provider Identifier
1164575478
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
AVENUE U ORTHODONTICS, PLLC
Practice address
79 Avenue U
Brooklyn, NY 11223-3554
Phone
(718) 373-6707
Fax
(888) 292-7017
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Authorized official

Name
Dr. Oleg Drut, DDSNPI 1619987757
Title
Owner
Phone
(201) 308-8181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X DI20707 NJ
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

79 Avenue U
Brooklyn, NY 11223-3554

Mailing address

15 Engle Street
Suite 204
Englewood, NJ 07631-2936
Phone (201) 308-8181

Other identifiers 2

IdentifierTypeStateIssuer
0045063MedicaidNJ
03128943MedicaidNY

Other names 1

  • Orthoclub PC Former legal business name

National Provider Directory

National Provider Directory

Locations

17 Summit Ave
Hackensack, NJ 07601
Phone (201) 308-8181

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1164575478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ENGLE STREET",
            "address_2": "SUITE 204",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312936",
            "telephone_number": "201-308-8181",
            "fax_number": "888-292-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 AVENUE U",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112233554",
            "telephone_number": "718-373-6707",
            "fax_number": "888-292-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVENUE U ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "DRUT",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-308-8181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "DI20707",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0045063",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03128943",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthoclub PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.