NPIMap

Individual provider Active NPI

Jessica Lillian Wollenberg, D.M.D

  • Oral and Maxillofacial Pathology Dentistry
  • Randolph, NJ
National Provider Identifier
1770801888
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
22DI02546000 Issued in NJ
Practice address
447 Route 10
Suite 5
Randolph, NJ 07869-2132
Phone
(973) 328-0464
Fax
(973) 328-3405
NPI assigned
May 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 22DI02546000 NJ Primary

Addresses

Primary practice location

447 Route 10
Suite 5
Randolph, NJ 07869-2132

Mailing address

447 Route 10
Suite 5
Randolph, NJ 07869-2132
Phone (973) 328-0464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140201000007 NJ Practitioner - Oral Surgery 3870722333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

447 Route 10
Suite 5
Randolph, NJ 07869-2132
Phone (973) 328-0464

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Randolph Oral Pathology Associates, LLC Oral and Maxillofacial Pathology CurrentSince Oct 21, 2013 Accepting new patients
Randolph Center for Oral and Maxillofacial Surgery, PA CurrentSince Oct 21, 2013 Accepting new patients

Locations

35 Beaverson Blvd
Ste 10A
Brick, NJ 08723
Phone (732) 920-8800

230 Route 206
Ste 105
Flanders, NJ 07836
Phone (973) 598-8423

447 State Route 10
Ste 5
Randolph, NJ 07869
Phone (973) 328-0464

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381190400000",
    "number": "1770801888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 ROUTE 10",
            "address_2": "SUITE 5",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078692132",
            "telephone_number": "973-328-0464",
            "fax_number": "973-328-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 ROUTE 10",
            "address_2": "SUITE 5",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078692132",
            "telephone_number": "973-328-0464",
            "fax_number": "973-328-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLENBERG",
        "first_name": "JESSICA",
        "middle_name": "LILLIAN",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-13",
        "last_updated": "2013-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NJ",
            "license": "22DI02546000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, NJ

Sources for this page

Verify at the official NPI Registry.