Alec Saul Eidelman, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1858348 Issued in MA

Practice address

1493 Cambridge St
Cambridge, MA 02139-1047

Phone

(617) 665-3990

NPI assigned

Jun 8, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cambridge Public Health Commission

  dba Cambridge Health Alliance

  • General Acute Care Hospital
  • Cambridge, MA
  • NPI 1932313228
  Medicare reassignment NPD
• Cambridge Public Health Commission

  dba Cambridge Health Alliance

  • General Acute Care Hospital
  • Cambridge, MA
  • NPI 1487603585
  NPD

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1679066245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 WINDSOR ST 2ND FLOOR",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393648",
            "telephone_number": "617-665-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDELMAN",
        "first_name": "ALEC",
        "middle_name": "SAUL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-08",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1858348",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Patrick Egan, MD
• Itua Eghe, DPT
• Shannon Egleson
• Luisa Ehrich
• Mary Katherine Eibye, PHARMD
• Haticha Atahanovna Eisenberg, FNP
• Jennifer Ashley Eitutis, DMD
• Obinna Ikechukwu Ekekezie, MD
• Sarah El Iskandarani, MD
• Rama El Yafawi, MD

• General Practice Dentistry in Cambridge, MA
• Providers in Cambridge, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.