Active NPI
Ozra F Modarres, DDS
- Dentist
- Lyndhurst, NJ
National Provider Identifier
1447417910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DI19996
- Practice address
- 217 Stuyvesant Ave
Lyndhurst, NJ 07071 - Phone
- (201) 438-5328
- Fax
- (201) 438-5823
- NPI assigned
- May 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DI19996 | NJ | Primary |
Addresses
Primary practice location
217 Stuyvesant Ave
Lyndhurst, NJ 07071
Mailing address
217 Stuyvesant Ave
Lyndhurst, NJ 07071
Phone (201) 438-5328
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 |
|---|---|---|---|
| DI19996 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1447417910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 STUYVESANT AVE",
"city": "LYNDHURST",
"state": "NJ",
"postal_code": "07071",
"telephone_number": "201-438-5328",
"fax_number": "201-438-5823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 STUYVESANT AVE",
"city": "LYNDHURST",
"state": "NJ",
"postal_code": "07071",
"telephone_number": "201-438-5328",
"fax_number": "201-438-5823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODARRES",
"first_name": "OZRA",
"middle_name": "F",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-21",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "DI19996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lyndhurst, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.