Marlen Martirossian, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02140900 Issued in NJ

Practice address

130 Kinderkamack Rd
Suite 306
River Edge, NJ 07661-1939

Phone

(201) 546-8512

Fax

(201) 488-4756

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

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.

• River Edge Family Dental

  • Dentist
  • River Edge, NJ
  • NPI 1346662012
  Authorized official Same address or phone

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1780734277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 KINDERKAMACK RD",
            "address_2": "SUITE 306",
            "city": "RIVER EDGE",
            "state": "NJ",
            "postal_code": "076611939",
            "telephone_number": "201-546-8512",
            "fax_number": "201-488-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 KINDERKAMACK RD",
            "address_2": "SUITE 306",
            "city": "RIVER EDGE",
            "state": "NJ",
            "postal_code": "076611939",
            "telephone_number": "201-546-8512",
            "fax_number": "201-488-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIROSSIAN",
        "first_name": "MARLEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2021-07-01",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02140900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianna Maranilli, BCBA
• Jenna Suzanne Marcella, LCSW, LCADC
• Margaret Ravits MD
• Michael Mariano, LPC, LCADC
• Mark S Goldfarb, MD, PA
• Joshua Bryan Masarof
• Julia Masur
• Sydney Kristine Mattera, PA-C
• William Frederick Maurice, LPC, LCADC
• Jodi A McLean, MSOTR/L

• General Practice Dentistry in River Edge, NJ
• Providers in River Edge, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.