NPIMap

Individual provider Active NPI

Maryam Farag

  • Oral and Maxillofacial Surgery (Dentist)
  • Rutherford, NJ
National Provider Identifier
1295076255
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
0238832 Issued in NY
Practice address
41 Preble PL
Rutherford, NJ 07070-2610
Phone
(201) 316-5423
NPI assigned
Mar 14, 2013
Last updated
Dec 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 0238832 NY Primary

Addresses

Primary practice location

41 Preble PL
Rutherford, NJ 07070-2610

Mailing address

41 Preble PL
Rutherford, NJ 07070-2610
Phone (201) 316-5423

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190218002814 NY Practitioner - Oral Surgery 0840538757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Tufts University School of Dental Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-5454

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0238832NYMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Jan 1, 2019 Accepting new patients
Weill Medical College of Cornell CurrentSince Jan 1, 2019 Accepting new patients
The New York and Presbyterian Hospital Past Accepting new patients

Locations

50 E 69th St
New York, NY 10021
Phone (212) 570-4000

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

525 E 68th St
Rm F2100
New York, NY 10065

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: maf9167@direct.weillcornell.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1295076255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 PREBLE PL",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702610",
            "telephone_number": "201-316-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 PREBLE PL",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702610",
            "telephone_number": "201-316-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARAG",
        "first_name": "MARYAM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-14",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "0238832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutherford, NJ

Sources for this page

Verify at the official NPI Registry.