Mordechai Fried
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · West Long Branch, NJ
NPI 1992320378 · NPPES record last updated Jul 25, 2025
Key facts
- NPI
- 1992320378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 22DI02952800 (NJ)
- Practice address
- 67 State Route 36
West Long Branch, NJ 07764-1432 - Phone
- (848) 228-2583
- NPI assigned
- Jun 11, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Orthodontics and Dentofacial Orthopedics
- Education
- Univ of Pennsylvania School of Dental Medicine, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
49 Hallberg Ave
Bergenfield, NJ 07621-2615
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260317000645 | NJ | Practitioner - Orthodontics and Dentofacial Orthopedics | 4385127497 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02952800 | NJ | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blvd Orthodontics LLC | Orthodontics and Dentofacial Orthopedics | Current |
Accepting new patients |
Locations
500 Boulevard of Americas
Ste 105
Lakewood, NJ 08701
Phone (848) 228-2583
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 22DI02952800 | NJ | Yes |
Addresses
Primary practice location
67 State Route 36
West Long Branch, NJ 07764-1432
Mailing address
5501 Old York Rd Ste 1
Philadelphia, PA 19141-3098
Phone (215) 456-6620
Other practice location 1
5501 Old York Rd Ste 1
Philadelphia, PA 19141-3098
Phone (215) 456-6620
Other providers in West Long Branch, NJ
- Brynlee Fischer
- Kristine Fisher
- Rachel Lynn Fornicola
- Danielle Freda
- Charles R Fredericks
- Sudha Ganne
- Garden State Neurology and Neuro-Oncology, PC
- Gary V Karakashian MD PA
- Paul Gennaro
- Chaya Gersten
All providers in West Long Branch, NJ · Orthodontics and Dentofacial Orthopedics Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.