Active NPI
Maryam Manouchehri, DMD
- General Practice Dentistry
- Pine Hill, NJ
National Provider Identifier
1235216342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 20691
- Practice address
- 1130 Blackwood Clementon Rd
Pine Hill, NJ 08021-6965 - Phone
- (856) 627-2400
- Fax
- (856) 783-2798
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20691 | NJ | Primary |
Addresses
Primary practice location
1130 Blackwood Clementon Rd
Pine Hill, NJ 08021-6965
Mailing address
1130 Blackwood Clementon Rd
Pine Hill, NJ 08021-6965
Phone (856) 627-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20691 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1235216342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 BLACKWOOD CLEMENTON RD",
"city": "PINE HILL",
"state": "NJ",
"postal_code": "080216965",
"telephone_number": "856-627-2400",
"fax_number": "856-783-2798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 BLACKWOOD CLEMENTON RD",
"city": "PINE HILL",
"state": "NJ",
"postal_code": "080216965",
"telephone_number": "856-627-2400",
"fax_number": "856-783-2798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANOUCHEHRI",
"first_name": "MARYAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "20691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Hill, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.