NPIMap

Individual provider Active NPI

Michael Ethan Skolnick, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Newark, NJ
National Provider Identifier
1427243476
Registry record updated Sep 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
22DI02353600 Issued in NJ
Practice address
66 Somme St
2ND Floor
Newark, NJ 07105-3612
Phone
(973) 578-8788
NPI assigned
Sep 12, 2007
Last updated
Sep 30, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 22DI02353600 NJ Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 052662-1 NY

Addresses

Primary practice location

66 Somme St
2ND Floor
Newark, NJ 07105-3612

Mailing address

515 Springfield Ave
Berkeley Heights, NJ 07922-1180
Phone (908) 464-6789

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

LicenseStateTypeSpecialty
22DI02353600NJMDOrthodontics and Dentofacial Orthopedic Dentist
052662-1NYMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Childsmiles, PA Orthodontics and Dentofacial Orthopedics Past Accepting new patients

Organizations & group practices 12

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": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412035200000",
    "number": "1427243476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 SPRINGFIELD AVE",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079221180",
            "telephone_number": "908-464-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 SOMME ST",
            "address_2": "2ND FLOOR",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071053612",
            "telephone_number": "973-578-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOLNICK",
        "first_name": "MICHAEL",
        "middle_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2014-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "22DI02353600",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "052662-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.