Active NPI
Marta Petryna
- Dentist
- East Rutherford, NJ
National Provider Identifier
1497108583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02649200
- Practice address
- 124 Park Ave
East Rutherford, NJ 07073-1938 - Phone
- (201) 500-9767
- Fax
- (201) 935-2221
- NPI assigned
- Jul 13, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02649200 | NJ | Primary |
| Dentist | 122300000X | DS041014 | PA |
Addresses
Primary practice location
124 Park Ave
East Rutherford, NJ 07073-1938
Mailing address
124 Park Ave
East Rutherford, NJ 07073-1938
Phone (201) 500-9767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161027002297 | PA | Order and Referring Only - Dentist | 4789962697 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02649200 | NJ | MD | Dentist |
| DS041014 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1497108583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 PARK AVE",
"city": "EAST RUTHERFORD",
"state": "NJ",
"postal_code": "070731938",
"telephone_number": "201-500-9767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 PARK AVE",
"city": "EAST RUTHERFORD",
"state": "NJ",
"postal_code": "070731938",
"telephone_number": "201-500-9767",
"fax_number": "201-935-2221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRYNA",
"first_name": "MARTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-13",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02649200",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS041014",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Rutherford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.