Jerome Scott Forman, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14638 Issued in NJ

Practice address

513 Boulevard
Kenilworth, NJ 07033-1637

Phone

(908) 276-6652

Fax

(908) 709-4337

NPI assigned

Nov 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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.

• Kenilworth Dental Associates, LLC

  • General Practice Dentistry
  • Kenilworth, NJ
  • NPI 1710064977
  NPD (past) Authorized official
• Mondovi Dental of New Jersey - Bejarano PC

  • General Practice Dentistry
  • Kenilworth, NJ
  • NPI 1700365129
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679650931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 BOULEVARD",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331637",
            "telephone_number": "908-276-6652",
            "fax_number": "908-709-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 BOULEVARD",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331637",
            "telephone_number": "908-276-6652",
            "fax_number": "908-709-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JEROME",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "14638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Yesenia Fermin, MSW, LCSW
• Lois G Fiore, OD
• Andrea J Frank, D O P C
• Jay Murray Gilden, DC
• Glenn W Koechling DDS
• Gracious Services Inc.
• Great Atlantic & Pacific Tea Company Inc (A & P Pharmacy)

• General Practice Dentistry in Kenilworth, NJ
• Providers in Kenilworth, NJ by specialty
• General Practice Dentistry in New Jersey

• 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.
• 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.