Kenneth Banasiak, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

22DI02217600 Issued in NJ

Practice address

65 South Maple Ave
Basking Ridge, NJ 07920

Phone

(908) 766-2444

Fax

(908) 221-9655

NPI assigned

Aug 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Nettune & Banasiak Orthodontics Associates

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Basking Ridge, NJ
  • NPI 1790984177
  NPD (past)

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186704000000",
    "number": "1336331628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 SOUTH MAPLE AVE",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "908-766-2444",
            "fax_number": "908-221-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 SOUTH MAPLE AVE",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "908-766-2444",
            "fax_number": "908-221-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANASIAK",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-10",
        "last_updated": "2007-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "22DI02217600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Chinenye Azubuike, NP
• Donna Marie Babyak, DMD
• Linda Bacino-Gamba, COTA
• Cynthia Balajadia, OTR/L
• Olivia Ayse Baldisserotto, F.N.P
• Rouba Barkoudeh
• Francesca Barrett, MD MBA
• Basking Ridge Fire Company No. 1
• Basking Ridge Pediatric Dentistry, LLC
• Basking Ridge Pediatric Health Center

• Orthodontics and Dentofacial Orthopedics Dentistry in Basking Ridge, NJ
• Providers in Basking Ridge, NJ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.

Verify at the official NPI Registry.