New Leaf Pediatric Dental LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

NEW LEAF PEDIATRIC DENTAL LLC

Practice address

2029 Lemoine Ave Ste 203
Fort Lee, NJ 07024-5731

Phone

(201) 592-0758

NPI assigned

Mar 16, 2018

Organization subpart

No

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

Authorized official

Name

Cherish Im, DDSNPI 1962759795

Title

Owner

Phone

(201) 592-0758

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cherish Im

  • Pediatric Dentistry
  • Fort Lee, NJ
  • NPI 1962759795
  NPD (past) Authorized official

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1649773524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 ROFF AVE UNIT B",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2029 LEMOINE AVE STE 203",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070245731",
            "telephone_number": "201-592-0758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LEAF PEDIATRIC DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "IM",
        "authorized_official_first_name": "CHERISH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-592-0758",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Fort Lee, NJ
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• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.