Active NPI
Kevin John Massarelli, D.M.D.
- Dentist
- Warren, NJ
National Provider Identifier
1891984365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DI15267
- Practice address
- 178 Mount Bethel Rd
Warren, NJ 07059-5147 - Phone
- (908) 647-8577
- NPI assigned
- Oct 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DI15267 | NJ | Primary |
Addresses
Primary practice location
178 Mount Bethel Rd
Warren, NJ 07059-5147
Mailing address
178 Mount Bethel Rd
Warren, NJ 07059-5147
Phone (908) 647-8577
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170227000068 | NJ | Order and Referring Only - Dentist | 7012291776 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI15267 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1891984365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "178 MOUNT BETHEL RD",
"city": "WARREN",
"state": "NJ",
"postal_code": "070595147",
"telephone_number": "908-647-8577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "178 MOUNT BETHEL RD",
"city": "WARREN",
"state": "NJ",
"postal_code": "070595147",
"telephone_number": "908-647-8577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSARELLI",
"first_name": "KEVIN",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-19",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "DI15267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; 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.