Individual provider Active NPI

Georgette Bennardo-Meggelin, D.D.S.

  • General Practice Dentistry
  • Teaneck, NJ
National Provider Identifier
1538285291
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22D101928900 Issued in NJ
Practice address
948 Teaneck Rd
Teaneck, NJ 07666-4504
Phone
(201) 836-2720
Fax
(201) 568-1007
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22D101928900 NJ Primary

Addresses

Primary practice location

948 Teaneck Rd
Teaneck, NJ 07666-4504

Mailing address

6428 84TH St
Middle Village, NY 11379-2424
Phone (718) 894-7538

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150721001117 NJ Order and Referring Only - DentistPractitioner - Dentist 7719290659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22D101928900NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538285291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6428 84TH ST",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113792424",
            "telephone_number": "718-894-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664504",
            "telephone_number": "201-836-2720",
            "fax_number": "201-568-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNARDO-MEGGELIN",
        "first_name": "GEORGETTE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22D101928900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.