Individual provider Active NPI

Bruce J Pines, D.D.S.

  • General Practice Dentistry
  • Mahwah, NJ
National Provider Identifier
1417092255
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13781 Issued in NJ
Practice address
115 Franklin Tpke
Mahwah, NJ 07430-1325
Phone
(201) 529-4441
Fax
(201) 529-1255
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 13781 NJ Primary

Addresses

Primary practice location

115 Franklin Tpke
Mahwah, NJ 07430-1325

Mailing address

818 High Mountain Rd
Franklin Lakes, NJ 07417-1618
Phone (201) 848-9541

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
I20160210000593 NJ Order and Referring Only - DentistPractitioner - Dentist 2567766611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13781NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417092255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 HIGH MOUNTAIN RD",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074171618",
            "telephone_number": "201-848-9541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 FRANKLIN TPKE",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301325",
            "telephone_number": "201-529-4441",
            "fax_number": "201-529-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINES",
        "first_name": "BRUCE",
        "middle_name": "J",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "13781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahwah, NJ

Sources for this page

Verify at the official NPI Registry.