NPIMap

Organization Active NPI

Woodbine Dental PA

  • Dentist
  • Woodbine, NJ
National Provider Identifier
1700919594
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI01877400 Issued in NJ
Legal business name
WOODBINE DENTAL PA
Practice address
901 Dehirsch Avenue
Woodbine, NJ 08270
Phone
(609) 861-2784
Fax
(609) 861-3160
NPI assigned
Mar 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jacques Nathan, DDSNPI 1942489919
Title
Dentist President
Phone
(609) 861-2784

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22DI00879400 NJ
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22DI01877400 NJ Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22DI01862600 NJ

Addresses

Primary practice location

901 Dehirsch Avenue
Woodbine, NJ 08270

Mailing address

901 Dehirsch Avenue
Woodbine, NJ 08270
Phone (609) 861-2784

Other identifiers 1

IdentifierTypeStateIssuer
2743906MedicaidNJ

National Provider Directory

National Provider Directory

Locations

901 Dehirsch Ave
Woodbine, NJ 08270
Phone (609) 861-2784

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700919594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 DEHIRSCH AVENUE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "08270",
            "telephone_number": "609-861-2784",
            "fax_number": "609-861-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 DEHIRSCH AVENUE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "08270",
            "telephone_number": "609-861-2784",
            "fax_number": "609-861-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBINE DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NATHAN",
        "authorized_official_first_name": "JACQUES",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "609-861-2784",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI00879400",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01877400",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01862600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2743906",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbine, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.