Active NPI
Erwin Park
- Oral and Maxillofacial Surgery (Dentist)
- Pompton Plains, NJ
National Provider Identifier
1730527243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 22DI02740400
- Practice address
- 28 Jackson Ave Ste 1
Pompton Plains, NJ 07444-1479 - Phone
- (973) 831-0382
- NPI assigned
- Jun 6, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 22DI02740400 | NJ | Primary |
Addresses
Primary practice location
28 Jackson Ave Ste 1
Pompton Plains, NJ 07444-1479
Mailing address
28 Jackson Ave Ste 1
Pompton Plains, NJ 07444-1479
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 17, 2019 through Jun 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02740400 | NJ | MD | Oral and Maxillofacial Surgery (Dentist) |
Interoperability endpoints
- erwin.park@xdr.hhchealthdirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563235200000",
"number": "1730527243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 JACKSON AVE STE 1",
"city": "POMPTON PLAINS",
"state": "NJ",
"postal_code": "074441479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 JACKSON AVE STE 1",
"city": "POMPTON PLAINS",
"state": "NJ",
"postal_code": "074441479",
"telephone_number": "973-831-0382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ERWIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-06",
"last_updated": "2019-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NJ",
"license": "22DI02740400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pompton Plains, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.