Active NPI
Jared Brett Shore, DMD
- Dentist
- New York, NY
National Provider Identifier
1962500041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 047815
- Practice address
- 30 Central Park South
Ste 3B
New York, NY 10019 - Phone
- (212) 832-0808
- Fax
- (212) 832-0347
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 047815 | NY | Primary |
Addresses
Primary practice location
30 Central Park South
Ste 3B
New York, NY 10019
Mailing address
30 Central Park South
Ste 3B
New York, NY 10019
Phone (212) 832-0808
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962500041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 CENTRAL PARK SOUTH",
"address_2": "STE 3B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10019",
"telephone_number": "212-832-0808",
"fax_number": "212-832-0347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 CENTRAL PARK SOUTH",
"address_2": "STE 3B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10019",
"telephone_number": "212-832-0808",
"fax_number": "212-832-0347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORE",
"first_name": "JARED",
"middle_name": "BRETT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "047815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
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.