Richard G Rosivack, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

13763 Issued in NJ

Practice address

381 Chestnut St
Union, NJ 07083-9430

Phone

(908) 686-2082

Fax

(908) 686-2149

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• R Glenn Rosivack Professional name

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1497822597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 CHESTNUT ST",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070839430",
            "telephone_number": "908-686-2082",
            "fax_number": "908-686-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 CHESTNUT ST",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070839430",
            "telephone_number": "908-686-2082",
            "fax_number": "908-686-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSIVACK",
        "first_name": "RICHARD",
        "middle_name": "G",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "13763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1345001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "R",
            "last_name": "ROSIVACK",
            "middle_name": "GLENN",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Pediatric Dentistry in Union, NJ
• Providers in Union, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.

Verify at the official NPI Registry.