Joseph Difazio, D.M.D.
Individual provider Active NPI Prosthodontics · West Long Branch, NJ
NPI 1235264227 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1235264227
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 3161 (NJ)
- Practice address
- 107 Monmouth Rd
Suite 101
West Long Branch, NJ 07764-1000 - Phone
- (732) 542-0011
- Fax
- (732) 542-9419
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Oral Surgery
- Education
- Other, 1978
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
107 Monmouth Rd
Suite 101
West Long Branch, NJ 07764-1021
Phone (732) 542-0011
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051206000579 | NJ | Practitioner - Oral Surgery | 8729008727 | Practice locations: W Long Branch, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3161 | NJ | MD | Prosthodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 22DI01294600 | NJ | |
| Prosthodontics | 1223P0700X | 3161 | NJ | Yes |
Addresses
Primary practice location
107 Monmouth Rd
Suite 101
West Long Branch, NJ 07764-1000
Mailing address
107 Monmouth Rd
Suite 101
West Long Branch, NJ 07764-1000
Phone (732) 542-0011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1160430 | Medicaid | NJ |
Other providers in West Long Branch, NJ
- Sarah Delzio
- Gautam J Desai
- Jilian Detiberiis
- Kenneth Dicarlo
- Jessica L Dickenman
- Danielle Dirmeitis
- Patrick R Discepola
- Danielle Marie Donato
- Dr. Steven Marder, LLC
- Kevin William Drew
All providers in West Long Branch, NJ · Prosthodontics 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 Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.