Active NPI
Martin David Pelavin, MD
- Internal Medicine Physician
- Old Tappan, NJ
National Provider Identifier
1386758217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MA03311200
- Practice address
- 215 Old Tappan Road
Old Tappan, NJ 07675 - Phone
- (201) 666-1000
- Fax
- (201) 666-4108
- NPI assigned
- Aug 18, 2006
- Last updated
- Nov 17, 2009
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MA03311200 | NJ | Primary |
Addresses
Primary practice location
215 Old Tappan Road
Old Tappan, NJ 07675
Mailing address
215 Old Tappan Road
Old Tappan, NJ 07675
Phone (201) 666-1000
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13336 | Other | USHC | |
| 221941517003 | Other | PRUDENTIAL | |
| 4250316 | Other | AETNA | |
| 6445171002 | Other | CIGNA | |
| BP028 | Other | OXFORD | |
| 18362 | Other | MASTERCARE | |
| 4727908 | Medicaid | NJ | |
| 998607 | Other | REFERRAL | |
| 80599 | Other | AMERIGROUP | |
| 1819727 | Other | UNITEDHLTHCR | |
| F01394 | Other | HEALTHNET | |
| 010033112NJ01 | Other | ANTHEM HEALTH | |
| 221941517 | Other | HORIZON BCBS | |
| 294071 | Other | EMPIRE HLTHCR |
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: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA03311200 | NJ | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Associates of Englewood, PC | Internal Medicine | Current | Accepting new patients |
Locations
24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123
215 Old Tappan Rd
Old Tappan, NJ 07675
Phone (201) 666-1000
Interoperability endpoints
- mpelavin236702@direct.englewoodhealth.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Englewood, NJ
- NPI 1952681918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258416000000",
"number": "1386758217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 OLD TAPPAN ROAD",
"city": "OLD TAPPAN",
"state": "NJ",
"postal_code": "07675",
"telephone_number": "201-666-1000",
"fax_number": "201-666-4108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 OLD TAPPAN ROAD",
"city": "OLD TAPPAN",
"state": "NJ",
"postal_code": "07675",
"telephone_number": "201-666-1000",
"fax_number": "201-666-4108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELAVIN",
"first_name": "MARTIN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2009-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "MA03311200",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "USHC",
"identifier": "13336",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRUDENTIAL",
"identifier": "221941517003",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4250316",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6445171002",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "BP028",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASTERCARE",
"identifier": "18362",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4727908",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REFERRAL",
"identifier": "998607",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "80599",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITEDHLTHCR",
"identifier": "1819727",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "F01394",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM HEALTH",
"identifier": "010033112NJ01",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HORIZON BCBS",
"identifier": "221941517",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE HLTHCR",
"identifier": "294071",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Old Tappan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.