Individual provider Active NPI

John Robert Mully, D.M.D.

  • General Practice Dentistry
  • Saddle Brook, NJ
National Provider Identifier
1891811956
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
337 Market St
Saddle Brook, NJ 07663-5313
Phone
(201) 843-6677
Fax
(201) 843-5285
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NJ Primary

Addresses

Primary practice location

337 Market St
Saddle Brook, NJ 07663-5313

Mailing address

337 Market St
Saddle Brook, NJ 07663-5313
Phone (201) 843-6677

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150526000085 NJ Order and Referring Only - DentistPractitioner - Dentist 5092035584

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DIO1171800NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Antithrombotic Center, LLC Past Accepting new patients
John R. Mully D.M.D., P.a. General Practice Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891811956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 MARKET ST",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "076635313",
            "telephone_number": "201-843-6677",
            "fax_number": "201-843-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 MARKET ST",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "076635313",
            "telephone_number": "201-843-6677",
            "fax_number": "201-843-5285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLY",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saddle Brook, NJ

Sources for this page

Verify at the official NPI Registry.