Active NPI
Raymond Kenneth Simmons, DDS, DMSC
- Dentist
- Long Branch, NJ
National Provider Identifier
1457425993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DI02526800
- Practice address
- 300 2ND Ave
Long Branch, NJ 07740-6303 - Phone
- (732) 923-6586
- Fax
- (732) 923-6599
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
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 | DI02526800 | NJ | Primary |
Addresses
Primary practice location
300 2ND Ave
Long Branch, NJ 07740-6303
Mailing address
300 2ND Ave
Long Branch, NJ 07740-6303
Phone (732) 923-6586
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100507708 | Medicaid | NV |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI02526800 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359072000000",
"number": "1457425993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 2ND AVE",
"city": "LONG BRANCH",
"state": "NJ",
"postal_code": "077406303",
"telephone_number": "732-923-6586",
"fax_number": "732-923-6588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 2ND AVE",
"city": "LONG BRANCH",
"state": "NJ",
"postal_code": "077406303",
"telephone_number": "732-923-6586",
"fax_number": "732-923-6599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "RAYMOND",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "DDS, DMSC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2013-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "DI02526800",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100507708",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Branch, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.