Individual provider Active NPI

Mariela Mitre, MD, PHD

  • Dermatology Physician
  • Hackensack, NJ
National Provider Identifier
1063918951
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25MA11424400 Issued in NJ
Practice address
360 Essex St Ste 201
Hackensack, NJ 07601-8566
Phone
(551) 996-8660
NPI assigned
Apr 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X 25MA11424400 NJ Primary

Addresses

Primary practice location

360 Essex St Ste 201
Hackensack, NJ 07601-8566

Mailing address

360 Essex St Ste 201
Hackensack, NJ 07601-8566
Phone (551) 996-8660

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
I20221029000350 NJ Practitioner - Dermatology 1052649647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
New York University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hackensack Meridian Health Medical Group - Specialty Care PCGroup PAC ID 9133032519, 1,901 clinicians

Practice addresses (Care Compare)

360 Essex St
Suite 201
Hackensack, NJ 07601-8566
Phone (551) 996-8660

Hospital & facility affiliations

  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions229
Removal or shaving of skin growth1-10
Skin biopsy244

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA11424400NJMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Aug 8, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Aug 8, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Past Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

360 Essex St
Ste 201
Hackensack, NJ 07601
Phone (201) 694-2488

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

Interoperability endpoints

  • Direct secure messaging: mariela.mitre@direct.hackensackmeridian.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1063918951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 ESSEX ST STE 201",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076018566",
            "telephone_number": "551-996-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 ESSEX ST STE 201",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076018566",
            "telephone_number": "551-996-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRE",
        "first_name": "MARIELA",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-01",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MA11424400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.