Individual provider Active NPI

Andriy Leshkiv, DMD

  • Periodontics
  • Marlton, NJ
National Provider Identifier
1538904404
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
22DI03029800 Issued in NJ
Practice address
149 Greentree Rd
Marlton, NJ 08053-9602
Phone
(856) 810-8400
NPI assigned
Jul 1, 2024
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 22DI03029800 NJ Primary

Addresses

Primary practice location

149 Greentree Rd
Marlton, NJ 08053-9602

Mailing address

149 Greentree Rd
Marlton, NJ 08053-9602
Phone (215) 596-9963

Other practice location 1

1815 New Rd
Northfield, NJ 08225-1101
Phone (609) 646-0333

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

LicenseStateTypeSpecialty
22DI03029800NJMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Greentree Dental Implants and Periodontics LLC Periodontics CurrentSince Jul 7, 2024 Accepting new patients
Atlantic Periodontics Periodontics PastSince Jan 12, 2020 Accepting new patients
Atlantic Periodontics LLC Periodontics Past Accepting new patients

Locations

149 Greentree Rd
Marlton, NJ 08053
Phone (609) 923-5577

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1538904404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 GREENTREE RD",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080539602",
            "telephone_number": "215-596-9963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 GREENTREE RD",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080539602",
            "telephone_number": "856-810-8400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 New Rd",
            "address_purpose": "LOCATION",
            "city": "Northfield",
            "state": "NJ",
            "postal_code": "082251101",
            "country_code": "US",
            "telephone_number": "609-646-0333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LESHKIV",
        "first_name": "ANDRIY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "22DI03029800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.