Active NPI
Mohannad Abboushi, DDS
- Dentist
- Bloomfield, NJ
National Provider Identifier
1689350837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02985800
- Practice address
- 194 Broad St
Bloomfield, NJ 07003-4394 - Phone
- (973) 250-6400
- NPI assigned
- Jun 23, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02985800 | NJ | Primary |
Addresses
Primary practice location
194 Broad St
Bloomfield, NJ 07003-4394
Mailing address
194 Broad St
Bloomfield, NJ 07003-4394
Phone (973) 250-6400
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
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02985800 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Family Dentistry LLC | Single Specialty | Current | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721865600000",
"number": "1689350837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "194 BROAD ST",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070034394",
"telephone_number": "973-250-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "194 BROAD ST",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070034394",
"telephone_number": "973-250-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABBOUSHI",
"first_name": "MOHANNAD",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-23",
"last_updated": "2024-07-25",
"certification_date": "2024-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02985800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.