Ralph Haime Civjan, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DS037465 Issued in PA

Practice address

100 N 3Rd St
2ND Floor
Easton, PA 18042-1869

Phone

(484) 526-7330

Fax

(610) 250-2735

NPI assigned

May 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Practice roles

Locations

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.

• Star Community Health, Inc

  • General Practice Physician
  • Bethlehem, PA
  • NPI 1033686159
  Medicare reassignment NPD
• Star Community Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Bethlehem, PA
  • NPI 1942832720
  NPD

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1710945654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 SUTTON PL",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180455757",
            "telephone_number": "610-252-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 3RD ST",
            "address_2": "2ND FLOOR",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180421869",
            "telephone_number": "484-526-7330",
            "fax_number": "610-250-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVJAN",
        "first_name": "RALPH",
        "middle_name": "HAIME",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "5256838",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS037465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chor Youth and Family Services, Inc.
• Matthew Chorney, M.D.
• Shivani Chudasama
• Charmaine Chuidian, PT
• Kevin Chung, O.D.
• CJ Optical Holdings LLC
• Alexa Clark
• April Clark, LSW
• Jessica Clark, RD, LDN
• Rachel Lynn Clark, PHARMD

• Pediatric Dentistry in Easton, PA
• Providers in Easton, PA by specialty
• Pediatric Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.