Marissa Halum, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DI02306000 Issued in NJ

Practice address

111 E Union Ave
Bound Brook, NJ 08805-1713

Phone

(732) 356-1830

Fax

(732) 356-0038

NPI assigned

Mar 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Comprehensive Pediatric Dentistry

  • Pediatric Dentistry
  • Bound Brook, NJ
  • NPI 1043441876
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841318078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 KENSINGTON AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073041805",
            "telephone_number": "201-434-3070",
            "fax_number": "732-356-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051713",
            "telephone_number": "732-356-1830",
            "fax_number": "732-356-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALUM",
        "first_name": "MARISSA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02306000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Bennet Goldstein, D.C.
• Green Valley Medical Equipment
• Green Valley Medical Equipment (Green Valley Pharmacy)
• Carmela Gutierrez, LPC
• Craig Haft, LSW
• Kimberly Ann Hansen, R.PH.
• Jabriel Harmon
• Eric Harris, LCWS
• Christine Heer, LCSW
• Roy Robert Henderson, DPM

• Pediatric Dentistry in Bound Brook, NJ
• Providers in Bound Brook, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.