Serena D Thomas, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02501800 Issued in NJ

Practice address

175 Old Tappan Rd
Old Tappan, NJ 07675-7042

Phone

(201) 768-7100

NPI assigned

Jul 31, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Serena D Jacob Former name

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

Practice roles

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.

• Andrea M. Mattia DDS LLC

  • Pediatric Dentistry
  • Old Tappan, NJ
  • NPI 1396674339
  NPD (past)

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

{
    "created_epoch": "1312070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1689952202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 OLD TAPPAN RD",
            "city": "OLD TAPPAN",
            "state": "NJ",
            "postal_code": "076757042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 OLD TAPPAN RD",
            "city": "OLD TAPPAN",
            "state": "NJ",
            "postal_code": "076757042",
            "telephone_number": "201-768-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "SERENA",
        "middle_name": "D",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-31",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02501800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SERENA",
            "last_name": "JACOB",
            "middle_name": "D",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jenna Stuebe, PT, DPT
• Sunhee Lee DMD PA
• SZR Old Tappan Assisted Living, LLC
• Nancy Kaplan Tancer, M.D.
• The Great Atlantic & Pacific Tea Co., Inc.
• Joseph Michael Torres, LSW
• Stephen G Varhol, MD
• Adelsia Vasquez
• Megan Villone
• Vip Helpers of NJ, LLC

• Dentist in Old Tappan, NJ
• Providers in Old Tappan, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.