Active NPI
George A Maryniuk, DDS
- Prosthodontics
- Brookline, MA
National Provider Identifier
1295936086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 14004
- Practice address
- 209 Harvard St
Suite 302
Brookline, MA 02446-5071 - Phone
- (617) 566-4108
- Fax
- (617) 566-4142
- NPI assigned
- May 30, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 14004 | MA | Primary |
Addresses
Primary practice location
209 Harvard St
Suite 302
Brookline, MA 02446-5071
Mailing address
209 Harvard St
Suite 302
Brookline, MA 02446-5071
Phone (617) 566-4108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14004 | Other | MA | STATE LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14004 | MA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sfrnsh LLC | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Brookline, MA
- NPI 1104380526
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295936086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 HARVARD ST",
"address_2": "SUITE 302",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465071",
"telephone_number": "617-566-4108",
"fax_number": "617-566-4142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 HARVARD ST",
"address_2": "SUITE 302",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465071",
"telephone_number": "617-566-4108",
"fax_number": "617-566-4142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARYNIUK",
"first_name": "GEORGE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MA",
"license": "14004",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "14004",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.