Fadi Beydoun, D.M.D
Individual provider Active NPI Periodontics · Avenel, NJ
NPI 1265559983 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1265559983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 19152 (NJ)
- Practice address
- 1030 Saint Georges Ave
Avenel, NJ 07001-1390 - Phone
- (732) 750-0707
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| I20150629002811 | NJ | Order and Referring Only - Dentist |
1254643562 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19152 | NJ | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 19152 | NJ | Yes |
Addresses
Primary practice location
1030 Saint Georges Ave
Avenel, NJ 07001-1390
Mailing address
1030 Saint Georges Ave
Avenel, NJ 07001-1390
Other providers in Avenel, NJ
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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.