Victor John Iradi, DMD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

DI018407 Issued in NJ

Practice address

1903 Atlantic Ave Ste 1
Manasquan, NJ 08736-1005

Phone

(732) 528-9799

Fax

(732) 528-8597

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

State licenses

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1720200421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 ATLANTIC AVE",
            "address_2": "BLDG B SUITE 1",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "08736",
            "telephone_number": "732-528-9799",
            "fax_number": "732-722-8344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 ATLANTIC AVE STE 1",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087361005",
            "telephone_number": "732-528-9799",
            "fax_number": "732-528-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRADI",
        "first_name": "VICTOR",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS028324L",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NJ",
            "license": "DI018407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MANASQUAN",
            "affiliation": "N",
            "address_1": "1903 Atlantic Ave Ste 1",
            "city": "Manasquan",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "087361005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthodontics in Manasquan, NJ
• Providers in Manasquan, NJ by specialty
• Prosthodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.