Individual provider Active NPI

Jeffrey Gliksman, DMD

  • General Practice Dentistry
  • Bergenfield, NJ
National Provider Identifier
1952498974
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI01628400 Issued in NJ
Practice address
155 North Washington Avenue
Bergenfield, NJ 07621-1742
Phone
(201) 384-3909
Fax
(201) 384-7373
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
No

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 22DI01628400 NJ Primary

Addresses

Primary practice location

155 North Washington Avenue
Bergenfield, NJ 07621-1742

Mailing address

155 North Washington Avenue
Bergenfield, NJ 07621-1742
Phone (201) 384-3909

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
I20160308002414 NJ Order and Referring Only - DentistPractitioner - Dentist 9234435850

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952498974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 NORTH WASHINGTON AVENUE",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076211742",
            "telephone_number": "201-384-3909",
            "fax_number": "201-384-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 NORTH WASHINGTON AVENUE",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076211742",
            "telephone_number": "201-384-3909",
            "fax_number": "201-384-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLIKSMAN",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01628400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bergenfield, NJ

Sources for this page

Verify at the official NPI Registry.