Individual provider Active NPI

Kemberley Gicella Valderrama, CNM

  • Advanced Practice Midwife
  • Paramus, NJ
National Provider Identifier
1104670470
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
Practice address
95 N State RT 17 Ste 105
Paramus, NJ 07652-2648
Phone
(201) 612-4737
NPI assigned
Apr 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X
Advanced Practice Midwife 367A00000X Primary

Addresses

Primary practice location

95 N State RT 17 Ste 105
Paramus, NJ 07652-2648

Mailing address

425 Marlboro Rd
Englewood, NJ 07631-1415
Phone (201) 921-5419

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240829002003 NJ Practitioner - Certified Nurse Midwife (CNM) 9638618036 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Physician Services PC CurrentSince Aug 18, 2024 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients

Locations

95 N State Rt 17
Paramus, NJ 07652
Phone (559) 676-8141

95 N State Rt 17
Ste 105
Paramus, NJ 07652
Phone (201) 612-4735

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

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.

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1104670470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MARLBORO RD",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311415",
            "telephone_number": "201-921-5419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 N STATE RT 17 STE 105",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522648",
            "telephone_number": "201-612-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDERRAMA",
        "first_name": "KEMBERLEY",
        "middle_name": "GICELLA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paramus, NJ

Sources for this page

Verify at the official NPI Registry.