Individual provider Active NPI

Gila Jedwab, DMD

  • Dentist
  • Lawrence, NY
National Provider Identifier
1669698064
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0498581 Issued in NY
Practice address
360 Central Ave
Suite 112
Lawrence, NY 11559
Phone
(516) 295-9203
NPI assigned
Apr 17, 2007
Sex
Female
Sole proprietor
Yes

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
Dentist 122300000X 0498581 NY Primary

Addresses

Primary practice location

360 Central Ave
Suite 112
Lawrence, NY 11559

Mailing address

400 Westminster Rd
Cedarhurst, NY 11516-1128
Phone (516) 569-2957

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0498581NYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669698064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WESTMINSTER RD",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161128",
            "telephone_number": "516-569-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 CENTRAL AVE",
            "address_2": "SUITE 112",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "11559",
            "telephone_number": "516-295-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDWAB",
        "first_name": "GILA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0498581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.