Individual provider Active NPI

Kelly Dowiak

  • Family Nurse Practitioner
  • Hoboken, NJ
National Provider Identifier
1023699725
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ01102900 Issued in NJ
Practice address
77 Park Ave Apt 903
Hoboken, NJ 07030-7111
Phone
(908) 414-0478
NPI assigned
Apr 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 345706 NY
Family Nurse Practitioner 363LF0000X 26NJ01102900 NJ Primary

Addresses

Primary practice location

77 Park Ave Apt 903
Hoboken, NJ 07030-7111

Mailing address

77 Park Ave Apt 903
Hoboken, NJ 07030-7111
Phone (908) 414-0478

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211117001112 NJ Practitioner - Nurse Practitioner 6002205804 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical Group of New JerseyGroup PAC ID 4082979166, 299 clinicians

Practice addresses (Care Compare)

704 Morris Tpke
Short Hills, NJ 07078-2614
Phone (973) 571-5350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ01102900NJMDFamily Nurse Practitioner
345706NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
DRX Paramus, LLC CurrentSince Jul 1, 2023 Accepting new patients
Jersey Irish Medical CurrentSince Aug 13, 2021 Accepting new patients
The Radiology Group of New Jersey, LLC CurrentSince Dec 1, 2024 Accepting new patients
Monmouth Digestive Health LLC PastSince Aug 17, 2020 Accepting new patients

Locations

601 W Union Ave
Bound Brook, NJ 08805
Phone (732) 469-3627

601 W Union Ave
Ste 1
Bound Brook, NJ 08805
Phone (732) 469-3627

145 Wyckoff Rd
Ste 201
Eatontown, NJ 07724
Phone (732) 597-7333

57 US Highway 46
Ste 212
Hackettstown, NJ 07840

651 Willow Grove St
Hackettstown, NJ 07840
Phone (908) 441-1161

175 High St
Newton, NJ 07860
Phone (973) 383-2121

222 High St
Ste 205
Newton, NJ 07860
Phone (973) 579-4060

67 E Ridgewood Ave
Unit C
Paramus, NJ 07652
Phone (201) 262-2010

704 Morris Tpke
Short Hills, NJ 07078
Phone (973) 379-8771

214 State Route 36
West Long Branch, NJ 07764
Phone (732) 222-8000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1023699725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 PARK AVE APT 903",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070307111",
            "telephone_number": "908-414-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 PARK AVE APT 903",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070307111",
            "telephone_number": "908-414-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOWIAK",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "345706",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ01102900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

Verify at the official NPI Registry.