Active NPI
Grigoriy Efros, D.M.D., MS
- Dentist
- Randolph, NJ
National Provider Identifier
1265828297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02578500
- Practice address
- 20 Fairfield Ave
Randolph, NJ 07869-1420 - Phone
- (973) 945-8178
- NPI assigned
- Apr 7, 2015
- Last updated
- Nov 13, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02578500 | NJ | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 058564-1 | NY |
Addresses
Primary practice location
20 Fairfield Ave
Randolph, NJ 07869-1420
Mailing address
20 Fairfield Ave
Randolph, NJ 07869-1420
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02578500 | NJ | MD | Dentist |
| 058564-1 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478995200000",
"number": "1265828297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 FAIRFIELD AVE",
"city": "RANDOLPH",
"state": "NJ",
"postal_code": "078691420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 FAIRFIELD AVE",
"city": "RANDOLPH",
"state": "NJ",
"postal_code": "078691420",
"telephone_number": "973-945-8178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EFROS",
"first_name": "GRIGORIY",
"name_prefix": "Dr.",
"credential": "D.M.D., MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-07",
"last_updated": "2016-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02578500",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "058564-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.