The Bedside Dentist LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE BEDSIDE DENTIST LLC

Practice address

1155 E Jersey St
Elizabeth, NJ 07201-2310

Phone

(609) 701-5100

NPI assigned

Nov 7, 2011

Organization subpart

No

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

Authorized official

Name

Mark LiebermanNPI 1902202138

Title

Manager

Phone

(609) 701-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Lieberman, PA

  • Medical Physician Assistant
  • Brooklyn, NY
  • NPI 1902202138
  NPD (past) Authorized official

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1316224215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 KIMBALL ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 E JERSEY ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072012310",
            "telephone_number": "609-701-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BEDSIDE DENTIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-07",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "LIEBERMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "609-701-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0275140",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Elizabeth, NJ
• Providers in Elizabeth, 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 Nov 7, 2011; 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.