Nima Mir Madjlessi, DDS,MSD,PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

20508 Issued in NJ

Practice address

E7 Brier Hill CT
East Brunswick, NJ 08816-3336

Phone

(732) 651-8470

Fax

(732) 651-8033

NPI assigned

Jul 6, 2006

Last updated

Feb 17, 2012By the provider in NPPES

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

Other identifiers 1

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

Credentials

Physician Assistant

State licenses

Practice roles

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.

• East Brunswick Periodontics and Dental Implants

  • Periodontics
  • East Brunswick, NJ
  • NPI 1194861591
  NPD (past) Authorized official

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1659303329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E7 BRIER HILL CT",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163336",
            "telephone_number": "732-651-8470",
            "fax_number": "732-651-8033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "E7 BRIER HILL CT",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163336",
            "telephone_number": "732-651-8470",
            "fax_number": "732-651-8033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIR MADJLESSI",
        "first_name": "NIMA",
        "name_prefix": "Dr.",
        "credential": "DDS,MSD,PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "20508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710151089",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamara Lynn Miller, MA, NCC, LAC
• Simone Milyavsky
• Mindspa Therapy & Counseling LLC
• Mint Family Dental LLC
• Jesse Mintz, MD
• Mira Vie at East Brunswick Opco LLC (Mira Vie at East Brunswick)
• Noushin Mirmadjlessi, MD
• Lauren Mitchell
• Debjit Mitra, OTR/L
• Narmin Farah Hussain Mizan, MD

• Periodontics in East Brunswick, NJ
• Providers in East Brunswick, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; 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.