Jaclyn Kirshbaum

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI03065000 Issued in NJ

Practice address

140 Market St FL 2
Paterson, NJ 07505-1471

Phone

(973) 742-4200

NPI assigned

Feb 4, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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 and National Provider Directory roles.

• Smile Central Dental Camden P.C.

  • General Practice Dentistry
  • Paterson, NJ
  • NPI 1467083576
  NPD
• Smile Central Orthodontics, P.C.

  • General Practice Dentistry
  • Paterson, NJ
  • NPI 1891478293
  NPD
• Smile Central Dover P.C.

  • Dentist
  • Dover, NJ
  • NPI 1033833843
  NPD (past)

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

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1598419079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MARKET ST FL 2",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051471",
            "telephone_number": "973-742-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MARKET ST FL 2",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051471",
            "telephone_number": "973-742-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSHBAUM",
        "first_name": "JACLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-04",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "LL908",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI03065000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sookhee Kim
• Vivian Jiyoung Kim, D.D.S.
• Jeffrey James Kinyon, D.O.
• Trixie Kioko-Kamps, CNM
• Charlotte Kirk, DO
• Kittery Dialysis LLC
• Serdal Brian Kocak, DDS
• Jalal Koj, MD
• Monika Komosinski, CRNA
• Mary T Kondoleon, MD

• General Practice Dentistry in Paterson, NJ
• Providers in Paterson, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.