Individual provider Active NPI

Danilo Correa, DDS

  • Dentist
  • Hackensack, NJ
National Provider Identifier
1790874014
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
385 Prospect Ave
2ND Floor
Hackensack, NJ 07601-2570
Phone
(201) 342-4369
Fax
(201) 342-4376
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NJ Primary

Addresses

Primary practice location

385 Prospect Ave
2ND Floor
Hackensack, NJ 07601-2570

Mailing address

385 Prospect Ave
2ND Floor
Hackensack, NJ 07601-2570
Phone (201) 342-4369

Other identifiers 1

IdentifierTypeStateIssuer
02408937MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Feb 22, 2016 through Feb 22, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
22DIO2226000NJMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1790874014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 PROSPECT AVE",
            "address_2": "2ND FLOOR",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076012570",
            "telephone_number": "201-342-4369",
            "fax_number": "201-342-4376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 PROSPECT AVE",
            "address_2": "2ND FLOOR",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076012570",
            "telephone_number": "201-342-4369",
            "fax_number": "201-342-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORREA",
        "first_name": "DANILO",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02408937",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.