Individual provider Active NPI

Marina A Alexandrova II, M.D.

  • Internal Medicine Physician
  • Nutley, NJ
National Provider Identifier
1073687240
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07474400 Issued in NJ
Practice address
460 Franklin Ave
Suite A2
Nutley, NJ 07110-2323
Phone
(973) 667-8640
Fax
(973) 667-0401
NPI assigned
Nov 20, 2006
Last updated
Jun 5, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07474400 NJ Primary

Addresses

Primary practice location

460 Franklin Ave
Suite A2
Nutley, NJ 07110-2323

Mailing address

460 Franklin Ave
Suite A2
Nutley, NJ 07110-2323
Phone (973) 667-8640

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
I20050908000637 NJ Practitioner - Internal Medicine 4284666454 Practice locations: Nutley, NJ

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

460 Franklin Ave
Nutley, NJ 07110-2323
Phone (973) 667-8640

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Group Services LLC CurrentSince Sep 10, 2012 Accepting new patients
Michael F. Durante, M.D. Past Accepting new patients

Locations

134 Evergreen Pl
Ste 501
East Orange, NJ 07018
Phone (862) 520-3902

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401926400000",
    "number": "1073687240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 FRANKLIN AVE",
            "address_2": "SUITE A2",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102323",
            "telephone_number": "973-667-8640",
            "fax_number": "973-667-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 FRANKLIN AVE",
            "address_2": "SUITE A2",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102323",
            "telephone_number": "973-667-8640",
            "fax_number": "973-667-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALEXANDROVA",
        "first_name": "MARINA",
        "middle_name": "A",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2014-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07474400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

Verify at the official NPI Registry.