Tomas Jose Ballesteros IV, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

50 054337 Issued in NY

Practice address

64 S 23Rd St
Kenilworth, NJ 07033-1630

Phone

(339) 221-1551

NPI assigned

May 1, 2009

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

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": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241136000000",
    "number": "1639303860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 S 23RD ST",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331630",
            "telephone_number": "339-221-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 S 23RD ST",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331630",
            "telephone_number": "339-221-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLESTEROS",
        "first_name": "TOMAS",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-01",
        "last_updated": "2009-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "50 054337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmad Kazemi MD PA
• Alice Dos Santos Amorim, LMT
• Andrea J Frank D O P C
• Ann Liu LLC
• Seewan Auyeung, PHARMD
• Gail Berman, M.D.
• Blossoming Skies Learning Consultants, LLC.
• Christia Marie Bogojovski, FNP-BC
• Borough of Kenilworth
• Boulevard Physical Therapy PC

• Dentist in Kenilworth, NJ
• Providers in Kenilworth, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; 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.