Individual provider Active NPI

George Norberg, DMD

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1568659142
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
048251 Issued in NY
Practice address
3200 Frankford Ave
Suite 2
Philadelphia, PA 19134-3217
Phone
(215) 739-5600
Fax
(215) 739-5600
NPI assigned
Sep 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 048251 NY Primary
General Practice Dentistry 1223G0001X DS031380L PA
General Practice Dentistry 1223G0001X 048251 NY
Dentist 122300000X DS031380L PA

Addresses

Primary practice location

3200 Frankford Ave
Suite 2
Philadelphia, PA 19134-3217

Mailing address

PO Box 409
Walton, NY 13856-0409
Phone (607) 345-3131

Other identifiers 1

IdentifierTypeStateIssuer
025877223MedicaidNY

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
DS031380LPAMDGeneral Practice Dentistry
048251NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1568659142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 409",
            "city": "WALTON",
            "state": "NY",
            "postal_code": "138560409",
            "telephone_number": "607-345-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 FRANKFORD AVE",
            "address_2": "SUITE 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191343217",
            "telephone_number": "215-739-5600",
            "fax_number": "215-739-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORBERG",
        "first_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-27",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "048251",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS031380L",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "048251",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS031380L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025877223",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.