Jennifer Marie Georgiadis, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

22DI02753800 Issued in NJ

Practice address

909 Ringwood Ave
Haskell, NJ 07420-1343

Phone

(973) 839-3434

NPI assigned

May 10, 2019

Last updated

May 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Marie Kotsikonas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• 5TH Avenue Dentistry and Implants, PLLC

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1962208215
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557446400000",
    "number": "1497311823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 PAVONIA AVE APT 3208",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073062958",
            "telephone_number": "917-576-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 RINGWOOD AVE",
            "city": "HASKELL",
            "state": "NJ",
            "postal_code": "074201343",
            "telephone_number": "973-839-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGIADIS",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-10",
        "last_updated": "2019-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "22DI02753800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KOTSIKONAS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edward Evanchick, P.T.
• Danielle Nicoletta Falciglia, PHD CCC-SLP
• Vanessa Fernandez
• Shannon Finn, CCC-SLP
• Jennan Gallanthen, RN
• Nancy Marie Gitin, PH.D.
• Mary N Guenther, MA, CCC-SLP
• Handa Rehab LLC
• Cindy Har
• Haskell Towne Medical, LLC

• Periodontics in Haskell, NJ
• Providers in Haskell, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.

Verify at the official NPI Registry.