Individual provider Active NPI

Ada Baisre-de Leon, M.D.

  • Neuropathology Physician
  • Newark, NJ
National Provider Identifier
1407015373
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuropathology PhysicianTaxonomy code 207ZN0500X
License
25MA08631000 Issued in NJ
Practice address
185 S Orange Ave
MSB C557
Newark, NJ 07103-2757
Phone
(973) 972-7167
NPI assigned
Jun 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X 25MA08631000 NJ
Neuropathology Physician 207ZN0500X 25MA08631000 NJ Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MA08631000 NJ

Addresses

Primary practice location

185 S Orange Ave
MSB C557
Newark, NJ 07103-2757

Mailing address

185 S Orange Ave
MSB C557
Newark, NJ 07103-2757
Phone (973) 972-7167

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091026000011 NJ Practitioner - Pathology 2769529700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician Associates of New Jersey IncGroup PAC ID 9830003417, 374 clinicians

Practice addresses (Care Compare)

150 Bergen St
Newark, NJ 07103-2496
Phone (973) 972-6936

Hospital & facility affiliations

  • The University Hospital Hospital, Newark, NJ, CCN 310119
  • Robert Wood Johnson University Hospital Hospital, New Brunswick, NJ, CCN 310038
  • Community Medical Center Hospital, Toms River, NJ, CCN 310041
  • Monmouth Medical Center Hospital, Long Branch, NJ, CCN 310075

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08631000NJMDMolecular Genetic Pathology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Associates of New Jersey Inc CurrentSince Jul 8, 2014 Accepting new patients
University Physician Associates of New Jersey Inc Neuropathology CurrentSince Jul 8, 2014 Accepting new patients

Locations

150 Bergen St
Newark, NJ 07103
Phone (973) 972-6056

30 Bergen St
Rm 1205
Newark, NJ 07107
Phone (973) 972-0037

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1407015373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 S ORANGE AVE",
            "address_2": "MSB C557",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032757",
            "telephone_number": "973-972-7167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 S ORANGE AVE",
            "address_2": "MSB C557",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032757",
            "telephone_number": "973-972-7167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAISRE-DE LEON",
        "first_name": "ADA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "NJ",
            "license": "25MA08631000",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Neuropathology",
            "state": "NJ",
            "license": "25MA08631000",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA08631000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.