Active NPI
Jae An, D.D.S.
- Dentist
- Little Falls, NJ
National Provider Identifier
1760820435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02532400
- Practice address
- 1540 US Highway 46
Little Falls, NJ 07424-1852 - Phone
- (973) 812-6550
- NPI assigned
- Jun 4, 2013
- Last updated
- Feb 27, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02532400 | NJ | Primary |
Addresses
Primary practice location
1540 US Highway 46
Little Falls, NJ 07424-1852
Mailing address
24812 Northern Blvd
2F
Little Neck, NY 11362-1206
Phone (718) 428-2663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150615001715 | NY | Order and Referring Only - Dentist | 0345551560 | |
| I20160418002259 | NJ | Order and Referring Only - Other (Physician) | 0345551560 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02532400 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393459200000",
"number": "1760820435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24812 NORTHERN BLVD",
"address_2": "2F",
"city": "LITTLE NECK",
"state": "NY",
"postal_code": "113621206",
"telephone_number": "718-428-2663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 US HIGHWAY 46",
"city": "LITTLE FALLS",
"state": "NJ",
"postal_code": "074241852",
"telephone_number": "973-812-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AN",
"first_name": "JAE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-04",
"last_updated": "2014-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02532400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Falls, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; 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.