Miriam Kerolus Fanouse

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02942100 Issued in NJ

Practice address

34 Mountain Blvd
Warren, NJ 07059-2640

Phone

(347) 307-1381

NPI assigned

Apr 16, 2014

Last updated

Mar 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1356761456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 BARTLETT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103122462",
            "telephone_number": "347-307-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 MOUNTAIN BLVD",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070592640",
            "telephone_number": "347-307-1381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112192916",
            "country_code": "US",
            "telephone_number": "718-283-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANOUSE",
        "first_name": "MIRIAM",
        "middle_name": "KEROLUS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02942100",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Essen Medical Urgicare of NJ PLLC
• Essilor Laboratories of America, Inc. (ELOA New Jersey)
• Christina M. Fabbricatore, LPC
• Family Dental Associates of Warren, LLC
• Chunbo Fan, LAC
• Janie Lynn Feldman, PSY.D.
• Maurice Andrew Ferrante, M.D.
• Riley D Fields, M.S.ED., SLP, SLS
• Sharon Filler, M.D.
• Kerry Marie Fine, PHARMD

• Dentist in Warren, NJ
• Providers in Warren, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.