Active NPI
Edward W. Boehm Jr., DMD
- General Practice Dentistry
- Passaic, NJ
National Provider Identifier
1942355813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13587
- Practice address
- 112 Lexington Ave
Passaic, NJ 07055-5244 - Phone
- (973) 777-6688
- NPI assigned
- Jan 23, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13587 | NJ | Primary |
Addresses
Primary practice location
112 Lexington Ave
Passaic, NJ 07055-5244
Mailing address
112 Lexington Ave
Passaic, NJ 07055-5244
Phone (973) 777-6688
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1616609 | Medicaid | NJ | |
| 10515 | Other | NJ | DORAL DENTAL IDENTIFIER |
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 |
|---|---|---|---|
| 13587 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942355813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 LEXINGTON AVE",
"city": "PASSAIC",
"state": "NJ",
"postal_code": "070555244",
"telephone_number": "973-777-6688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 LEXINGTON AVE",
"city": "PASSAIC",
"state": "NJ",
"postal_code": "070555244",
"telephone_number": "973-777-6688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOEHM",
"first_name": "EDWARD",
"middle_name": "W.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "13587",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1616609",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL IDENTIFIER",
"identifier": "10515",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Passaic, NJ
Sources for this page
- 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.