Active NPI
Daniil Libov
- Dentist
- Warren, NJ
National Provider Identifier
1366778920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02425500
- Practice address
- 37 Mountain Blvd
Suite 4
Warren, NJ 07059-2622 - Phone
- (646) 932-1185
- NPI assigned
- Nov 2, 2009
- Last updated
- Nov 2, 2009
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02425500 | NJ | Primary |
Addresses
Primary practice location
37 Mountain Blvd
Suite 4
Warren, NJ 07059-2622
Mailing address
PO Box 290149
Brooklyn, NY 11229-0149
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 |
|---|---|---|---|
| 22DI02425500 | NJ | MD | Dentist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257120000000",
"number": "1366778920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 290149",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112290149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 MOUNTAIN BLVD",
"address_2": "SUITE 4",
"city": "WARREN",
"state": "NJ",
"postal_code": "070592622",
"telephone_number": "646-932-1185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBOV",
"first_name": "DANIIL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-02",
"last_updated": "2009-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02425500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.