Active NPI
Marielle Johnson, D.M.D
- General Practice Dentistry
- Edgewater, NJ
National Provider Identifier
1487067708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 059588-1
- Practice address
- 1033 River Rd
Edgewater, NJ 07020-1351 - Phone
- (215) 760-1003
- NPI assigned
- Jun 4, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 059588-1 | NY | Primary |
Addresses
Primary practice location
1033 River Rd
Edgewater, NJ 07020-1351
Mailing address
1033 River Rd
Edgewater, NJ 07020-1351
Phone (215) 760-1003
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 |
|---|---|---|---|
| 059588-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567987200000",
"number": "1487067708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 RIVER RD",
"city": "EDGEWATER",
"state": "NJ",
"postal_code": "070201351",
"telephone_number": "215-760-1003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1033 RIVER RD",
"city": "EDGEWATER",
"state": "NJ",
"postal_code": "070201351",
"telephone_number": "215-760-1003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARIELLE",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-04",
"last_updated": "2019-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "059588-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edgewater, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.