Individual provider Active NPI

Ellen Ann O'Neill, C.N.M

  • Midwife
  • Jersey City, NJ
National Provider Identifier
1114036803
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
25ME00012001 Issued in NJ
Practice address
714 Bergen Ave
Jersey City, NJ 07306-4802
Phone
(201) 434-7906
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X 25ME00012001 NJ Primary

Addresses

Primary practice location

714 Bergen Ave
Jersey City, NJ 07306-4802

Mailing address

75 Bennett Ave
Kearny, NJ 07032-3113
Phone (201) 997-3535

Other identifiers 1

IdentifierTypeStateIssuer
1479601MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
25ME00012001NJMDMidwife

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114036803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BENNETT AVE",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070323113",
            "telephone_number": "201-997-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 BERGEN AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073064802",
            "telephone_number": "201-434-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'NEILL",
        "first_name": "ELLEN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "C.N.M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "NJ",
            "license": "25ME00012001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1479601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.