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RANDOLPH ORAL PATHOLOGY ASSOCIATES, LLC
NPI 1053745117
Dentist - Oral and Maxillofacial Pathology in Randolph, NJ

Active since August 26, 2013
447 ROUTE 10, SUITE 5, RANDOLPH, NJ 07869(973) 328-0464 Get Directions Write a Review

NPPES record last updated: January 7, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Randolph Oral Pathology Associates, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RANDOLPH ORAL PATHOLOGY ASSOCIATES, LLC (NPI 1053745117) is a healthcare organization registered as an oral and maxillofacial pathology in Randolph, New Jersey and active in the NPI registry since August 2013. The organization lists Jessica L Wollenberg, Sole Mbr, as its authorized official.

NPPES Registry Identity

NPI1053745117
Entity TypeOrganization
Primary Taxonomy1223P0106X
Legal Business NameRANDOLPH ORAL PATHOLOGY ASSOCIATES, LLC
Location Address447 ROUTE 10, SUITE 5Randolph, NJ 07869-2132
Mailing Address447 Route 10, Suite 5Randolph, NJ 07869-2132 · (973) 328-0464
Phone(973) 328-0464
Organization SubpartNo
Authorized OfficialJessica L WollenbergSole Mbr · (973) 945-9309
Enumeration DateAugust 26, 2013
Last NPPES UpdateJanuary 7, 2014
✔ NPI 1053745117 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial PathologyDental Providers
Taxonomy Code1223P0106X
License✔ Licensed in NJ · 22DI02546000
Definition
The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.
447 ROUTE 10, Randolph, NJ 07869
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Randolph Oral Pathology Associates, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew JerseyEnrollment IDO20131213000550Non-DME Part B · Clinic/Group PracticeDue dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Randolph Oral Pathology Associates, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jessica Wollenberg, D.M.D
Oral Surgery
NPI 1770801888
447 ROUTE 10 SUITE 5
Randolph, NJ 07869
(973) 328-0464
✔ PECOS✔ Accepts Medicare2.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Randolph Oral Pathology Associates, LLC's NPI number?

The NPI number for Randolph Oral Pathology Associates, LLC is 1053745117. It was assigned to this organization in the NPPES registry on August 26, 2013.

Where is Randolph Oral Pathology Associates, LLC located?

Randolph Oral Pathology Associates, LLC is located at 447 Route 10 Suite 5, Randolph, NJ 07869. The listed phone number is (973) 328-0464.

What is Randolph Oral Pathology Associates, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Pathology, with taxonomy code 1223P0106X.

Is Randolph Oral Pathology Associates, LLC enrolled in Medicare?

Yes. Randolph Oral Pathology Associates, LLC is registered in the Medicare PECOS enrollment system.

When is Randolph Oral Pathology Associates, LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New Jersey, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Randolph Oral Pathology Associates, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Oral Surgery) reassigns their Medicare billing to Randolph Oral Pathology Associates, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Randolph Oral Pathology Associates, LLC was last updated on January 7, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.