Individual provider Active NPI

Jeffrey Krantz, DDS

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1720180011
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
36034 Issued in NY
Practice address
645 E 11TH St
Apartment 1-G
New York, NY 10009-4134
Phone
(212) 979-6300
Fax
(212) 202-4173
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 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 36034 NY Primary

Addresses

Primary practice location

645 E 11TH St
Apartment 1-G
New York, NY 10009-4134

Mailing address

645 E 11TH St
Apartment 1-G
New York, NY 10009-4134
Phone (212) 979-6300

Other identifiers 2

IdentifierTypeStateIssuer
00693307MedicaidNY
13-4028528OtherNYTAX ID

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210303000202 NJ Practitioner - Dentist 6103232939 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36034NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Visiting Nurse Association of Central Jersey Community Health Center I CurrentSince Mar 8, 2021 Accepting new patients
Visiting Nurse Association of Central Jersey Community Health Center I CurrentSince Mar 8, 2021 Accepting new patients

Locations

1301 Main St
Asbury Park, NJ 07712
Phone (732) 774-6333

35 Broad St
Keyport, NJ 07735
Phone (732) 888-4149

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1720180011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 E 11TH ST",
            "address_2": "APARTMENT 1-G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100094134",
            "telephone_number": "212-979-6300",
            "fax_number": "212-202-4173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E 11TH ST",
            "address_2": "APARTMENT 1-G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100094134",
            "telephone_number": "212-979-6300",
            "fax_number": "212-202-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRANTZ",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "36034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00693307",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX  ID",
            "identifier": "13-4028528",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.