Carrie R. Mallen

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00174800 Issued in NJ

Practice address

370 Summit Ave
Hackensack, NJ 07601-1413

Phone

(201) 525-1777

Fax

(201) 525-0149

NPI assigned

Jun 5, 2008

Last updated

Oct 15, 2009By 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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jeffrey Rapaport,MD,PAGroup PAC ID 2062510977, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Jeffrey Rapaport,MD,PA

  • Procedural Dermatology Physician
  • Englewood Cliffs, NJ
  • NPI 1184777427
  Medicare reassignment Care Compare group
• Allen N. Sapadin, M.D., LLC

  • Procedural Dermatology Physician
  • Hackensack, NJ
  • NPI 1629190939
  NPD (past)
• Sovereign Medical Group LLC

  • Urology Physician
  • Oradell, NJ
  • NPI 1710282082
  NPD (past)

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255564800000",
    "number": "1558520577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 SUMMIT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011413",
            "telephone_number": "201-525-1777",
            "fax_number": "201-525-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 SUMMIT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011413",
            "telephone_number": "201-525-1777",
            "fax_number": "201-525-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLEN",
        "first_name": "CARRIE",
        "middle_name": "R.",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2009-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00174800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Malabanan, PHARMD
• Hiten M Malde, MD
• Maria Connie Malgieri, MSW, LCSW
• Danish Sohaib Malik, MD
• Quratul Ain Malik, DDS
• Grace Malley, MD
• Rajit Bhoosa Malliah, M.D.
• Mary Fares Mallouhi, DDS
• Katherine Malmrose, M.S., CCC-SLP
• Mam Orthopaedics, PA (Sports Medicine and Orthopaedic Center of New Jersey)

• Medical Physician Assistant in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; 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.