Individual provider Active NPI

Juliette Marella Fajardo Ruiz, MD

  • Neonatal-Perinatal Medicine Physician
  • New York, NY
National Provider Identifier
1356987697
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
347647 Issued in NY
Practice address
3959 Broadway
New York, NY 10032-1559
Phone
(212) 305-5827
Fax
(212) 305-7086
NPI assigned
Nov 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 324647 NY
Neonatal-Perinatal Medicine Physician 2080N0001X 347647 NY Primary

Addresses

Primary practice location

3959 Broadway
New York, NY 10032-1559

Mailing address

3959 Broadway
New York, NY 10032-1559
Phone (212) 305-5827

Other names 1

  • Dr. Juliette Marella Whitney Former name

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230919001001 NY Practitioner - Pediatric Medicine 5698139061 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
347647NYMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Pediatrics Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 1, 2023 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 1, 2023 Accepting new patients

Locations

400 Kelby St
Fl 9
Fort Lee, NJ 07024

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: voa9002@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1356987697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3959 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321559",
            "telephone_number": "212-305-5827",
            "fax_number": "212-305-7086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3959 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321559",
            "telephone_number": "212-305-5827",
            "fax_number": "212-305-7086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJARDO RUIZ",
        "first_name": "JULIETTE",
        "middle_name": "MARELLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "324647",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "347647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIETTE",
            "last_name": "WHITNEY",
            "middle_name": "MARELLA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.