NPIMap

Organization Active NPI

Jason Nudelman, DDS PC

Doing business as East Brunswick Pediatric Dentistry

  • Pediatric Dentistry
  • East Brunswick, NJ
National Provider Identifier
1245697788
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
22DI02298700 Issued in NJ
Legal business name
JASON NUDELMAN, DDS PC
Doing business as
East Brunswick Pediatric Dentistry
Practice address
17 Brunswick Woods Dr
East Brunswick, NJ 08816-5601
Phone
(732) 238-5100
Fax
(732) 238-0792
NPI assigned
Jan 27, 2016
Last updated
Aug 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Authorized official

Name
Shannon B Pitt
Title
Office Manager
Phone
(856) 291-6888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 22DI02298700 NJ Primary

Addresses

Primary practice location

17 Brunswick Woods Dr
East Brunswick, NJ 08816-5601

Mailing address

975 Tuckerton Rd Ste 201
Marlton, NJ 08053-2663
Phone (856) 291-6888

Other names 1

  • East Brunswick Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

975 Tuckerton Rd
Ste 201
Marlton, NJ 08053

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1453852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1245697788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 TUCKERTON RD STE 201",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532663",
            "telephone_number": "856-291-6888",
            "fax_number": "856-985-3412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 BRUNSWICK WOODS DR",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088165601",
            "telephone_number": "732-238-5100",
            "fax_number": "732-238-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON NUDELMAN, DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-27",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "PITT",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "856-291-6888"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02298700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Brunswick Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; 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.