Active NPI
Diana Khaitov, PA
- Physician Assistant
- Belleville, NJ
National Provider Identifier
1346564028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00183400
- Practice address
- 1 Clara Maass Dr
Clara Maass Medical Center
Belleville, NJ 07109-3550 - Phone
- (973) 450-2000
- Fax
- (973) 251-1109
- NPI assigned
- Mar 24, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00183400 | NJ | Primary |
Addresses
Primary practice location
1 Clara Maass Dr
Clara Maass Medical Center
Belleville, NJ 07109-3550
Mailing address
PO Box 717
Livingston, NJ 07039-0717
Phone (800) 345-0064
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00183400 | NJ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clara Maass Emergency Medical Associates LLC | Past | Accepting new patients | |
| Emergency Medical Associates of New Jersey PA | Past | Accepting new patients | |
| Emergency Medical Associates of New Jersey PA | Past | Accepting new patients |
Organizations & group practices 5
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.
-
- Emergency Medicine Physician
- Summit, NJ
- NPI 1497783419
-
- Hospitalist Physician
- Edison, NJ
- NPI 1588021851
-
- Emergency Medicine Physician
- Belleville, NJ
- NPI 1447516000
-
- Emergency Medicine Physician
- Morristown, NJ
- NPI 1477591360
-
- Emergency Medicine Physician
- Long Branch, NJ
- NPI 1841456068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1346564028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 717",
"city": "LIVINGSTON",
"state": "NJ",
"postal_code": "070390717",
"telephone_number": "800-345-0064",
"fax_number": "973-251-1109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CLARA MAASS DR",
"address_2": "CLARA MAASS MEDICAL CENTER",
"city": "BELLEVILLE",
"state": "NJ",
"postal_code": "071093550",
"telephone_number": "973-450-2000",
"fax_number": "973-251-1109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAITOV",
"first_name": "DIANA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-24",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00183400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; 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.