Active NPI
Amanda Blair Eidelson, DDS
- Endodontics
- Cherry Hill, NJ
National Provider Identifier
1922393750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 22DI02526300
- Practice address
- 303 Kings Hwy S Ste 6
Cherry Hill, NJ 08034-2579 - Phone
- (856) 429-7811
- Fax
- (856) 429-7819
- NPI assigned
- Jun 9, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 22DI02526300 | NJ | Primary |
Addresses
Primary practice location
303 Kings Hwy S Ste 6
Cherry Hill, NJ 08034-2579
Mailing address
303 Kings Hwy S Ste 6
Cherry Hill, NJ 08034-2579
Phone (856) 429-7811
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02526300 | NJ | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Exclusively Endodontics PA | Endodontics | Past | Accepting new patients |
| Bronxcare Health System | 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.
-
- Dental Clinic/Center
- Bronx, NY
- NPI 1851717219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1922393750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 KINGS HWY S STE 6",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080342579",
"telephone_number": "856-429-7811",
"fax_number": "856-429-7811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 KINGS HWY S STE 6",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080342579",
"telephone_number": "856-429-7811",
"fax_number": "856-429-7819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDELSON",
"first_name": "AMANDA",
"middle_name": "BLAIR",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-09",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NJ",
"license": "22DI02526300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cherry Hill, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.