Diane Amberg-Borsellino, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20031 Issued in NJ

Practice address

118 N Beverwyck Rd
Lake Hiawatha, NJ 07034-2294

Phone

(973) 334-8258

Fax

(973) 334-3617

NPI assigned

Feb 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

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

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689713125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N BEVERWYCK RD",
            "city": "LAKE HIAWATHA",
            "state": "NJ",
            "postal_code": "070342294",
            "telephone_number": "973-334-8258",
            "fax_number": "973-334-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N BEVERWYCK RD",
            "city": "LAKE HIAWATHA",
            "state": "NJ",
            "postal_code": "070342294",
            "telephone_number": "973-334-8258",
            "fax_number": "973-334-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBERG-BORSELLINO",
        "first_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "20031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lake Hiawatha, NJ
• Providers in Lake Hiawatha, 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.