Brendon L Ursomanno

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02939400 Issued in NJ

Practice address

317 NJ-34
Suite 203
Colts Neck, NJ 07722

Phone

(732) 677-2777

NPI assigned

Jan 31, 2023

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1689370843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SPARKILL AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103043134",
            "telephone_number": "718-987-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 NJ-34",
            "address_2": "SUITE 203",
            "city": "COLTS NECK",
            "state": "NJ",
            "postal_code": "07722",
            "telephone_number": "732-677-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URSOMANNO",
        "first_name": "BRENDON",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02939400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Colts Neck, NJ
• Providers in Colts Neck, 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 Jan 31, 2023; 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.