Sijo Devasia

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00584000 Issued in NJ

Practice address

385 Morris Ave FL 2
Springfield, NJ 07081-1151

Phone

(973) 379-2111

Fax

(973) 379-2807

NPI assigned

Nov 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

Practice roles

Locations

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.

• Robert Wood Johnson Medical Associates at Hamilton PA

  • General Practice Physician
  • Linden, NJ
  • NPI 1619206828
  Medicare reassignment NPD
• Immediate Care Medical Walk-in of Hazlet, PA

  • Urgent Care Clinic/Center
  • Hazlet, NJ
  • NPI 1245595313
  Medicare reassignment
• Practice Associates Medical Group

  • Internal Medicine Physician
  • Morristown, NJ
  • NPI 1427016385
  Medicare reassignment
• Urgent Care Physicians of New Jersey, LLC

  • Emergency Medicine Physician
  • Red Bank, NJ
  • NPI 1447622402
  Medicare reassignment

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1366046492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 MORRIS AVE FL 2",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070811151",
            "telephone_number": "973-379-2111",
            "fax_number": "973-379-2807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "741 Northfield Ave Ste 203",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070521104",
            "country_code": "US",
            "telephone_number": "973-379-2111",
            "fax_number": "973-379-2807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVASIA",
        "first_name": "SIJO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00584000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taleen J Demirdjian, LSW
• Dental Health Providers of New Jersey PC
• Dental Kidz Pediatric Dentistry LLC
• Rohan Gaurang Desai, DPM
• Ved Desai, D.O.
• Developmental Disabilities Association NJ Inc.
• Developmental Disabilities Association of NJ Inc.
• Isaiah Markedwin Dewar
• Diane Chazen, LLC
• Becky Diaz, LMFT

• Physician Assistant in Springfield, NJ
• Providers in Springfield, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.

Verify at the official NPI Registry.