NPIMap

Organization Active NPI

Eastern Orthodontic Associates, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Avenel, NJ
National Provider Identifier
1992866537
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
09744 Issued in NJ
Legal business name
EASTERN ORTHODONTIC ASSOCIATES, LLC
Practice address
1030 Saint Georges Ave
Avenel, NJ 07001-1390
Phone
(732) 750-2730
Fax
(732) 636-1844
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert Segall, D.M.D
Title
Director of Orthodontics
Phone
(732) 750-2730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 09744 NJ Primary

Addresses

Primary practice location

1030 Saint Georges Ave
Avenel, NJ 07001-1390

Mailing address

1030 Saint Georges Ave
Avenel, NJ 07001-1390

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992866537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011390",
            "telephone_number": "732-750-2730",
            "fax_number": "732-636-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN ORTHODONTIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SEGALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR OF ORTHODONTICS",
        "authorized_official_telephone_number": "732-750-2730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "09744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avenel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.