1801800461 NPI number — DR. GREGORY JON NEWMAN DMD

Table of content: TRINA FRY (NPI 1588380927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801800461 NPI number — DR. GREGORY JON NEWMAN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
GREGORY
Provider Middle Name:
JON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801800461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 N BROAD STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LANSDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-855-1173
Provider Business Mailing Address Fax Number:
215-855-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 N BROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-855-1173
Provider Business Practice Location Address Fax Number:
215-855-1936
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  DS029004L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 054393 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054393 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6440 . This is a "AMERICAN ASSOC. OF ENDODO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89839 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DS029004L . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1560 . This is a "AETNA DMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50012 . This is a "PA DENTAL ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113237 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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