Active NPI
Robert J Defalco, DDS
- Oral and Maxillofacial Pathology Dentistry
- Paramus, NJ
National Provider Identifier
1831110345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- DI078613
- Practice address
- 30 W Century Rd
Suite 210
Paramus, NJ 07652-1433 - Phone
- (201) 261-0170
- Fax
- (201) 261-0145
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | DI078613 | NJ | Primary |
Addresses
Primary practice location
30 W Century Rd
Suite 210
Paramus, NJ 07652-1433
Mailing address
30 W Century Rd
Suite 210
Paramus, NJ 07652-1433
Phone (201) 261-0170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8069506 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI078613 | NJ | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1831110345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 W CENTURY RD",
"address_2": "SUITE 210",
"city": "PARAMUS",
"state": "NJ",
"postal_code": "076521433",
"telephone_number": "201-261-0170",
"fax_number": "201-261-0145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 W CENTURY RD",
"address_2": "SUITE 210",
"city": "PARAMUS",
"state": "NJ",
"postal_code": "076521433",
"telephone_number": "201-261-0170",
"fax_number": "201-261-0145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFALCO",
"first_name": "ROBERT",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "NJ",
"license": "DI078613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8069506",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paramus, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.