Individual provider Active NPI

Gerard T Freda, DMD

  • General Practice Dentistry
  • Livingston, NJ
National Provider Identifier
1376636860
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17272 Issued in NJ
Practice address
65 E Northfield Rd Ste B
Livingston, NJ 07039-4525
Phone
(973) 533-5700
Fax
(973) 533-5707
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 17272 NJ Primary

Addresses

Primary practice location

65 E Northfield Rd Ste B
Livingston, NJ 07039-4525

Mailing address

65 E Northfield Rd Ste B
Livingston, NJ 07039-4525
Phone (973) 533-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150507002356 NJ Order and Referring Only - DentistPractitioner - Dentist 4587983846

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17272NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1376636860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 E NORTHFIELD RD STE B",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394525",
            "telephone_number": "973-533-5700",
            "fax_number": "973-533-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 E NORTHFIELD RD STE B",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394525",
            "telephone_number": "973-533-5700",
            "fax_number": "973-533-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDA",
        "first_name": "GERARD",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "17272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.