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Organization Active NPI

Mountainside Family Practice Associates - Merit

  • Family Medicine Physician
  • Verona, NJ
National Provider Identifier
1528199890
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNTAINSIDE FAMILY PRACTICE ASSOCIATES - MERIT
Practice address
799 Bloomfield Avenue
Suite 201
Verona, NJ 07044-0000
Phone
(973) 746-7050
Fax
(973) 857-2831
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Authorized official

Name
Mr. Barry Dykes, MR.
Title
C E O
Phone
(973) 429-6000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0010X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

799 Bloomfield Avenue
Suite 201
Verona, NJ 07044-0000

Mailing address

799 Bloomfield Ave
Suite 201
Verona, NJ 07044-1367
Phone (973) 746-7050

Other identifiers 1

IdentifierTypeStateIssuer
4138708MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Mountainside Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 South St
Ste 342
Morristown, NJ 07960

200 South St
Ste 3
Morristown, NJ 07960
Phone (973) 889-6800

200 South St
Ste 313
Morristown, NJ 07960

100 Madison Ave
#100
Morristown, NJ 07960
Phone (973) 971-4208

33 Overlook Rd
Ste L03
Summit, NJ 07901
Phone (908) 522-5730

33 Overlook Rd
Ste 103
Summit, NJ 07901
Phone (908) 522-5700

799 Bloomfield Ave
Ste 201
Verona, NJ 07044
Phone (973) 259-3566

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195603200000",
    "number": "1528199890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "799 BLOOMFIELD AVE",
            "address_2": "SUITE 201",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441367",
            "telephone_number": "973-746-7050",
            "fax_number": "973-857-2831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 BLOOMFIELD AVENUE",
            "address_2": "SUITE 201",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070440000",
            "telephone_number": "973-746-7050",
            "fax_number": "973-857-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE FAMILY PRACTICE ASSOCIATES - MERIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-11-21",
        "status": "A",
        "authorized_official_last_name": "DYKES",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "C E O",
        "authorized_official_telephone_number": "973-429-6000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MR."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4138708",
            "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 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.