Active NPI
Suprema Dancel Naim, MD
- Pediatrics Physician
- Passaic, NJ
National Provider Identifier
1528275807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MAO63245
- Practice address
- 148 8TH St.
Passaic, NJ 07055 - Phone
- (973) 470-3000
- NPI assigned
- May 17, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MAO63245 | NJ | Primary |
Addresses
Primary practice location
148 8TH St.
Passaic, NJ 07055
Mailing address
23 Hopper LN
Wayne, NJ 07470-4656
Phone (973) 694-2810
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140402000856 | NJ | Order and Referring Only - Pediatric Medicine | 0648401745 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAO63245 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528275807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 HOPPER LN",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074704656",
"telephone_number": "973-694-2810",
"fax_number": "973-694-2810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 8TH ST.",
"city": "PASSAIC",
"state": "NJ",
"postal_code": "07055",
"telephone_number": "973-470-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAIM",
"first_name": "SUPREMA",
"middle_name": "DANCEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "MAO63245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Passaic, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.