Active NPI
Georgeann Wallden
- Physician Assistant
- Hamilton, NJ
National Provider Identifier
1407480353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00561600
- Practice address
- 1544 Kuser Rd Ste C9
Hamilton, NJ 08619-3830 - Phone
- (734) 373-0849
- NPI assigned
- Mar 1, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00561600 | NJ | Primary |
Addresses
Primary practice location
1544 Kuser Rd Ste C9
Hamilton, NJ 08619-3830
Mailing address
2119 Gallagher Ave
Scotch Plains, NJ 07076-2607
Phone (917) 923-4941
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024706 | NY | MD | Occupational Therapist |
| 25MP00561600 | NJ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Current | Accepting new patients | |
| Montefiore Medical Center | Current | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
600 E 233rd St
Bronx, NY 10466
Phone (718) 920-1640
Interoperability endpoints
- georgeann.wallden@597174495543300.direct.elationemr.com
- gwallden45221@epicdirect.rwjbh.org
Organizations & group practices 5
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.
-
- Psychiatry Physician
- Flanders, NJ
- NPI 1346906179
-
- Anesthesiology Physician
- Bronx, NY
- NPI 1063525152
-
- Addiction Medicine (Family Medicine) Physician
- Philadelphia, PA
- NPI 1588244750
NY
-
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
-
- Family Medicine Physician
- New York, NY
- NPI 1760288278
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633651200000",
"number": "1407480353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2119 GALLAGHER AVE",
"city": "SCOTCH PLAINS",
"state": "NJ",
"postal_code": "070762607",
"telephone_number": "917-923-4941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1544 KUSER RD STE C9",
"city": "HAMILTON",
"state": "NJ",
"postal_code": "086193830",
"telephone_number": "734-373-0849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLDEN",
"first_name": "GEORGEANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-01",
"last_updated": "2021-10-08",
"certification_date": "2021-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00561600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hamilton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.