Epp New Jersey LLC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

EPP NEW JERSEY LLC

Practice address

71 Valley St Ste 100
South Orange, NJ 07079-2825

Phone

(862) 250-6952

NPI assigned

Oct 17, 2024

Organization subpart

No

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

Authorized official

Name

Jason Bertollini

Title

Credentialing Manager

Phone

(315) 450-0763

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1194546770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1584",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370241584",
            "telephone_number": "315-450-0763",
            "fax_number": "615-422-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 VALLEY ST STE 100",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792825",
            "telephone_number": "862-250-6952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPP NEW JERSEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "BERTOLLINI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "315-450-0763"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics in South Orange, NJ
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.