Individual provider Active NPI

Nermine Doss, MD

  • Pediatrics Physician
  • Secaucus, NJ
National Provider Identifier
1063509958
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA06769200 Issued in NJ
Practice address
714 10TH St
Secaucus, NJ 07094-2921
Phone
(201) 863-3346
Fax
(201) 552-2358
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA06769200 NJ Primary

Addresses

Primary practice location

714 10TH St
Secaucus, NJ 07094-2921

Mailing address

38 Meadowlands Pkwy
Secaucus, NJ 07094-2925
Phone (551) 257-7038

Other identifiers 1

IdentifierTypeStateIssuer
9052305MedicaidNJ

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121220000305 NJ Practitioner - Pediatric Medicine 4385896331 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06769200NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2016 Accepting new patients
Optum Medical Care of New Jersey PC Pediatrics CurrentSince Aug 1, 2016 Accepting new patients
Advanced Laparoscopic Associates Past Accepting new patients
Riverside Medical Group Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

38 Meadowlands Pkwy
Secaucus, NJ 07094
Phone (201) 866-5151

714 10th St
Secaucus, NJ 07094
Phone (201) 863-3346

38 Meadowlands Pkwy
Ste 2
Secaucus, NJ 07094
Phone (201) 864-6868

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Interoperability endpoints

  • Direct secure messaging: ndoss77209@direct.optum.com

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1063509958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 MEADOWLANDS PKWY",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "070942925",
            "telephone_number": "551-257-7038",
            "fax_number": "201-552-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 10TH ST",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "070942921",
            "telephone_number": "201-863-3346",
            "fax_number": "201-552-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOSS",
        "first_name": "NERMINE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA06769200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9052305",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Secaucus, NJ

Sources for this page

Verify at the official NPI Registry.