Sebu Idiculla, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02241500 Issued in NJ

Practice address

5 Sicomac Rd
Suite 12
North Haledon, NJ 07508-2972

Phone

(973) 423-3399

Fax

(973) 423-4828

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1245306406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SICOMAC RD",
            "address_2": "SUITE 12",
            "city": "NORTH HALEDON",
            "state": "NJ",
            "postal_code": "075082972",
            "telephone_number": "973-423-3399",
            "fax_number": "973-423-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SICOMAC RD",
            "address_2": "SUITE 12",
            "city": "NORTH HALEDON",
            "state": "NJ",
            "postal_code": "075082972",
            "telephone_number": "973-423-3399",
            "fax_number": "973-423-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULLA",
        "first_name": "SEBU",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02241500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lorena Huamancaja
• Anna J Huh, D.M.D.
• Innova Counseling and Wellness Center, Inc.
• Interventional Spine and Pain Treatment Center, PC
• Alyssa Jackler
• Jenna Janso
• Kaleidoscope Disabilities Inc

• General Practice Dentistry in North Haledon, NJ
• Providers in North Haledon, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.