Active NPI
Joan of Arc Mariyampillai, M.D.
- Internal Medicine Physician
- Verona, NJ
National Provider Identifier
1417916727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MA070156
- Practice address
- 825 Bloomfield Ave
Suite LL-1
Verona, NJ 07044-1366 - Phone
- (973) 239-3770
- Fax
- (973) 239-3774
- NPI assigned
- Mar 23, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MA070156 | NJ | Primary |
Addresses
Primary practice location
825 Bloomfield Ave
Suite LL-1
Verona, NJ 07044-1366
Mailing address
10 Florence PL
Caldwell, NJ 07006-5608
Phone (862) 251-4690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8929602 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA070156 | NJ | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Essex Medical Group PA | Internal Medicine | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699401600000",
"number": "1417916727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 FLORENCE PL",
"city": "CALDWELL",
"state": "NJ",
"postal_code": "070065608",
"telephone_number": "862-251-4690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 BLOOMFIELD AVE",
"address_2": "SUITE LL-1",
"city": "VERONA",
"state": "NJ",
"postal_code": "070441366",
"telephone_number": "973-239-3770",
"fax_number": "973-239-3774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIYAMPILLAI",
"first_name": "JOAN OF ARC",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2023-11-08",
"certification_date": "2023-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "MA070156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8929602",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Verona, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.