Active NPI
Ishan Poudel, MD
- Pediatrics Physician
- Paterson, NJ
National Provider Identifier
1356965057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA12807400
- Practice address
- 703 Main St
Paterson, NJ 07503-2621 - Phone
- (973) 754-2510
- NPI assigned
- May 29, 2020
- Reactivated
- Feb 2, 2022
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA12807400 | NJ | Primary |
Addresses
Primary practice location
703 Main St
Paterson, NJ 07503-2621
Mailing address
703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
331 Newman Springs Rd
Red Bank, NJ 07701-5688
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1013806 | MA | MD | Pediatrics Physician |
Interoperability endpoints
- ipoudel37373@direct.bostonchildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786147200000",
"number": "1356965057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 MAIN ST",
"city": "PATERSON",
"state": "NJ",
"postal_code": "075032621",
"telephone_number": "973-754-2510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 MAIN ST",
"city": "PATERSON",
"state": "NJ",
"postal_code": "075032621",
"telephone_number": "973-754-2510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POUDEL",
"first_name": "ISHAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-29",
"last_updated": "2026-08-08",
"certification_date": "2026-08-08",
"deactivation_date": "2022-01-18",
"reactivation_date": "2022-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA12807400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paterson, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.