Individual provider Active NPI

Joel F. Mac-Attoh Sr.

  • Psychiatric/Mental Health Nurse Practitioner
  • Trenton, NJ
National Provider Identifier
1255182457
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
26NJ15041300 Issued in NJ
Practice address
411 Breunig Ave
Trenton, NJ 08638-4409
Phone
(646) 981-7025
NPI assigned
Mar 27, 2024
Last updated
Mar 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 26NJ15041300 NJ Primary

Addresses

Primary practice location

411 Breunig Ave
Trenton, NJ 08638-4409

Mailing address

411 Breunig Ave
Trenton, NJ 08638-4409
Phone (646) 981-7025

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240814002937 NJ Practitioner - Nurse Practitioner 2264970896 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NJ Memory and Behavioral CareGroup PAC ID 7719013267, 71 clinicians

Practice addresses (Care Compare)

14 Ridgedale Ave
Suite 103
Cedar Knolls, NJ 07927-1106
Phone (973) 295-6335

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ15041300NJMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
NJ Memory and Behavioral Care CurrentSince Jun 15, 2024 Accepting new patients
Loving Heart Behavioral Health Care LLC CurrentSince Oct 26, 2024 Accepting new patients

Locations

14 Ridgedale Ave
Ste 103
Cedar Knolls, NJ 07927
Phone (973) 295-6335

575 Route 28
Bldg 2
Raritan, NJ 08869
Phone (973) 295-6335

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.

NPI Registry JSON

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

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1255182457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 BREUNIG AVE",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086384409",
            "telephone_number": "646-981-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 BREUNIG AVE",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086384409",
            "telephone_number": "646-981-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAC-ATTOH",
        "first_name": "JOEL",
        "middle_name": "F.",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ15041300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.