Active NPI
Jonathan H Feder
- Dentist
- Teaneck, NJ
National Provider Identifier
1376801951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02531800
- Practice address
- 710 Queen Anne Rd
Teaneck, NJ 07666-3316 - Phone
- (201) 692-1633
- NPI assigned
- May 2, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02531800 | NJ | Primary |
| Dentist | 122300000X | 056916 | NY |
Addresses
Primary practice location
710 Queen Anne Rd
Teaneck, NJ 07666-3316
Mailing address
710 Queen Anne Rd
Teaneck, NJ 07666-3316
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160113000966 | NJ | Order and Referring Only - Oral Surgery | 6305148917 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056916 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381363200000",
"number": "1376801951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 QUEEN ANNE RD",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076663316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 QUEEN ANNE RD",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076663316",
"telephone_number": "201-692-1633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDER",
"first_name": "JONATHAN",
"middle_name": "H",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-02",
"last_updated": "2013-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02531800",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "056916",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.