Individual provider Active NPI

Michael De Lorenzo, DMD

  • General Practice Dentistry
  • Totowa, NJ
National Provider Identifier
1720166275
Registry record updated Jul 8, 2007
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI 01595300 Issued in NJ
Practice address
169 Union Blvd
2-F
Totowa, NJ 07512-2603
Phone
(201) 787-8549
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22DI 01595300 NJ Primary

Addresses

Primary practice location

169 Union Blvd
2-F
Totowa, NJ 07512-2603

Mailing address

81 Elcock Ave
Boonton, NJ 07005-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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

Enrollment IDStateProvider typePAC IDDetails
I20200210000455 DC Order and Referring Only - DentistPractitioner - Dentist 0244666329

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI 01595300NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720166275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 ELCOCK AVE",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 UNION BLVD",
            "address_2": "2-F",
            "city": "TOTOWA",
            "state": "NJ",
            "postal_code": "075122603",
            "telephone_number": "201-787-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LORENZO",
        "first_name": "MICHAEL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI 01595300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Totowa, NJ

Sources for this page

Verify at the official NPI Registry.