Fanta Mian

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01202000 Issued in NJ

Practice address

25 E Salem St
Hackensack, NJ 07601-7427

Phone

(973) 534-2734

NPI assigned

Oct 19, 2021

Sex

Female

Sole proprietor

Yes

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fmian386043@epicdirect.rwjbh.org

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.

• Baraka Psychiatric Healthcare LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mountainside, NJ
  • NPI 1114881372
  Medicare reassignment NPD Authorized official
• Comprehensive Behavioral Healthcare, Inc.

  • Mental Health Counselor
  • Lyndhurst, NJ
  • NPI 1134176720
  Medicare reassignment NPD
• Rutgers Health - Behavioral Health

  • Psychiatry Physician
  • Cherry Hill, NJ
  • NPI 1891956298
  Medicare reassignment NPD
• Rutgers Health - Behavioral Health

  • Psychiatry Physician
  • Piscataway, NJ
  • NPI 1144267337
  NPD

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1477216224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2552 STANDISH AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070834939",
            "telephone_number": "973-534-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E SALEM ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017427",
            "telephone_number": "973-534-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIAN",
        "first_name": "FANTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-19",
        "last_updated": "2022-06-02",
        "certification_date": "2022-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01202000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Marie Meudt
• Carissa L Meyer, MD
• Philip Meyer, MD
• Mi Durable
• Korshed A Miah, MD
• Erick Miao, DO
• Michael D Seidner, M.D.,Facog, P.a.
• Michael Esposito, M.D., LLC
• Zuzanna Michalak, MD
• Mary Ann E Michelis, MD

• Psychiatric/Mental Health Nurse Practitioner in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.