Individual provider Active NPI

Nima Patel, DMD

  • Dentist
  • New York, NY
National Provider Identifier
1760539142
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
061051 Issued in NY
Practice address
345 E 24TH St
New York, NY 10010-4020
Phone
(212) 998-9613
NPI assigned
Jan 5, 2007
Last updated
Jul 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 061051 NY Primary
General Practice Dentistry 1223G0001X 22DI02245600 NJ

Addresses

Primary practice location

345 E 24TH St
New York, NY 10010-4020

Mailing address

225 N Martine Ave
Fanwood, NJ 07023-1336
Phone (908) 322-7111

Other practice location 1

225 N Martine Ave
Fanwood, NJ 07023-1336
Phone (908) 322-7111

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
I20160512001209 NJ Order and Referring Only - DentistPractitioner - Dentist 2961791058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
061051NYMDDentist
22DI02245600NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Dental Group, Inc. General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1760539142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N MARTINE AVE",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231336",
            "telephone_number": "908-322-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E 24TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100104020",
            "telephone_number": "212-998-9613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 N Martine Ave",
            "address_purpose": "LOCATION",
            "city": "Fanwood",
            "state": "NJ",
            "postal_code": "070231336",
            "country_code": "US",
            "telephone_number": "908-322-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "NIMA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "061051",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02245600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.