Active NPI
Christopher Pellicano, DDS
- Endodontics
- Ocean, NJ
National Provider Identifier
1366980096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 06875
- Practice address
- 1398 Hwy 35
Ocean, NJ 07712-3543 - Phone
- (732) 531-9200
- NPI assigned
- Feb 1, 2017
- Last updated
- Jan 26, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02797500 | NJ | |
| Endodontics | 1223E0200X | 061034 | NY | |
| Endodontics | 1223E0200X | 06875 | NJ | Primary |
Addresses
Primary practice location
1398 Hwy 35
Ocean, NJ 07712-3543
Mailing address
1398 NJ-35
Ocean Township, NJ 07712
Phone (732) 531-9200
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 |
|---|---|---|---|
| 22DI02797500 | NJ | MD | Dentist |
| 06875 | NJ | MD | Endodontist |
| 061034 | NY | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sachem Oral Surgery, PLLC | Past | Accepting new patients | |
| Sound Sleep Solutions LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Oral and Maxillofacial Surgery (Dentist)
- Nesconset, NY
- NPI 1669795332
-
- Dentist
- Nesconset, NY
- NPI 1750028924
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1366980096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1398 NJ-35",
"city": "OCEAN TOWNSHIP",
"state": "NJ",
"postal_code": "07712",
"telephone_number": "732-531-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1398 HWY 35",
"city": "OCEAN",
"state": "NJ",
"postal_code": "077123543",
"telephone_number": "732-531-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLICANO",
"first_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-01",
"last_updated": "2023-01-26",
"certification_date": "2023-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02797500",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "061034",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NJ",
"license": "06875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ocean, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.