Jerry J Popeck, DMD PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DI019021 Issued in NJ

Practice address

133 North Broadway
Suite B
Pennsville, NJ 08070

Phone

(856) 678-6393

Fax

(856) 678-6816

NPI assigned

Jan 17, 2007

Reactivated

Dec 16, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Popeck Family Dentistry

  • General Practice Dentistry
  • Pennsville, NJ
  • NPI 1346518362
  NPD (past) Authorized official

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418688000000",
    "number": "1972655017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 NORTH BROADWAY",
            "address_2": "SUITE B",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "08070",
            "telephone_number": "856-678-6393",
            "fax_number": "856-678-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 NORTH BROADWAY",
            "address_2": "SUITE B",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "08070",
            "telephone_number": "856-678-6393",
            "fax_number": "856-678-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPECK",
        "first_name": "JERRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2014-12-16",
        "deactivation_date": "2012-01-18",
        "reactivation_date": "2014-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI019021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Petersen, RPH
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• Danielle Cristin Plum, RPH
• Popeck Family Dentistry
• Shaukat M Qureshi, M.D
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• Resources for Independent Living, Inc.
• Resources for Independent Living, Inc.

• General Practice Dentistry in Pennsville, NJ
• Providers in Pennsville, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.

Verify at the official NPI Registry.