Active NPI
Marwan M Jallad, DDS
- Dentist
- West Nyack, NY
National Provider Identifier
1336294982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 043263
- Practice address
- 14 Doscher Avenue
West Nyack, NY 10994 - Phone
- (845) 727-4124
- Fax
- (845) 727-4128
- NPI assigned
- Jan 24, 2007
- Last updated
- Sep 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 043263 | NY | Primary |
Addresses
Primary practice location
14 Doscher Avenue
West Nyack, NY 10994
Mailing address
14 Doscher Avenue
West Nyack, NY 10994
Phone (845) 727-4124
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01283421 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160509001569 | NY | Order and Referring Only - Other (Physician) | 1850690124 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1336294982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 DOSCHER AVENUE",
"city": "WEST NYACK",
"state": "NY",
"postal_code": "10994",
"telephone_number": "845-727-4124",
"fax_number": "845-727-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 DOSCHER AVENUE",
"city": "WEST NYACK",
"state": "NY",
"postal_code": "10994",
"telephone_number": "845-727-4124",
"fax_number": "845-727-4128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JALLAD",
"first_name": "MARWAN",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "043263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01283421",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Nyack, NY
- Integrated Medical Professionals PLLC
- J.B.Katz-Gerrish, DO, PC
- Martina Treesa Jacob
- Noble Kurian Jacob, M.D.
- Atish Jaiswal, MD
- Siobhan James
- JD Senior Home Care, Inc. (Home Instead)
- Natalie Kathryn Jensen, AU.D.
- Jewish Family Service of Rockland County, Inc. (Rockland Jewish Family Service)
- JF Medical Services, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.