Mallory Vicedomini, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1057 Commerce Ave
Union, NJ 07083-5025

Phone

(866) 467-1770

NPI assigned

Oct 10, 2024

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Jersey Sports Medicine and Orthopedic Center, LLCGroup PAC ID 6709895733, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mvicedomini549151@direct.ahsys.org

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.

• North Jersey Sports Medicine and Orthopedic Center LLC

  • Specialist
  • Hackettstown, NJ
  • NPI 1619025038
  Medicare reassignment Care Compare group NPD
• Igea Brain & Spine,PA

  • Neurological Surgery Physician
  • Union, NJ
  • NPI 1710103288
  Medicare reassignment
• North Jersey Sports Medicine & Orthopedic Center, LLC

  dba The Orthopedic Institute of NJ

  • Specialist
  • Morristown, NJ
  • NPI 1417575531
  NPD

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1447070909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 COMMERCE AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070835025",
            "telephone_number": "866-467-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 COMMERCE AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070835025",
            "telephone_number": "866-467-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICEDOMINI",
        "first_name": "MALLORY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Masumi Van Buren, RN
• Allison Vanhook, DPT
• Sona Vaswani
• Lisa Verdi, LCSW
• Robert Verhoeven, BCBA
• Enrique N Victoria Jr., NP-C
• Joseph Vidal, RP
• Lance Viernes, DDS
• Michael Joseph Viksjo, MD
• Stephanie Vilarinho

• Physician Assistant in Union, NJ
• Providers in Union, 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 Nov 21, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.