Individual provider Active NPI

Andrew Shyong, D.D.S.

  • General Practice Dentistry
  • Closter, NJ
National Provider Identifier
1669692653
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DI02256700 Issued in NJ
Practice address
235 Closter Dock Rd
Closter, NJ 07624-1907
Phone
(201) 768-6101
Fax
(201) 768-2370
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DI02256700 NJ Primary

Addresses

Primary practice location

235 Closter Dock Rd
Closter, NJ 07624-1907

Mailing address

50 Collins Ave
Closter, NJ 07624-2817

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150611002779 NJ Order and Referring Only - DentistPractitioner - Dentist 2961723242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI02256700NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669692653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 COLLINS AVE",
            "city": "CLOSTER",
            "state": "NJ",
            "postal_code": "076242817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 CLOSTER DOCK RD",
            "city": "CLOSTER",
            "state": "NJ",
            "postal_code": "076241907",
            "telephone_number": "201-768-6101",
            "fax_number": "201-768-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHYONG",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI02256700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Closter, NJ

Sources for this page

Verify at the official NPI Registry.