Theodore A Niebloom, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

22DI01604200 Issued in NJ

Practice address

101 Old Short Hills Road
West Orange, NJ 07052

Phone

(973) 736-7616

Fax

(973) 325-3487

NPI assigned

Oct 31, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1689750705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OLD SHORT HILLS ROAD",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "07052",
            "telephone_number": "973-736-7616",
            "fax_number": "973-325-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OLD SHORT HILLS ROAD",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "07052",
            "telephone_number": "973-736-7616",
            "fax_number": "973-325-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEBLOOM",
        "first_name": "THEODORE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI01604200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seth Newman
• Next Step Orthopaedics, Inc
• Tiffany NG, PHARMD
• Pascaline Ngu
• Anthony Nicotera, J.D., DSW, LCSW
• Jeremiah David Nieves, M.D.
• Shaine Easo Ninan, PHARM D, RPH
• NJ Allergy MD, LLC
• NJ Endovascular & Amputation Prevention LLC
• NJ Multi-Disciplinary Medical Associates LLC

• Oral and Maxillofacial Surgery (Dentist) in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.