Individual provider Active NPI

Mary Grace M. Tolentino, NP-C

  • Primary Care Nurse Practitioner
  • Teaneck, NJ
National Provider Identifier
1578000550
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
26NJ00704900 Issued in NJ
Practice address
618 Tilden Ave
Teaneck, NJ 07666-1846
Phone
(201) 982-1227
NPI assigned
Jan 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 26NJ00704900 NJ Primary

Addresses

Primary practice location

618 Tilden Ave
Teaneck, NJ 07666-1846

Mailing address

618 Tilden Ave
Teaneck, NJ 07666-1846
Phone (201) 982-1227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170408000018 NJ Practitioner - Nurse Practitioner 3870879729 Reassigns benefits to 3 organizations
I20240731000982 FL Practitioner - Nurse Practitioner 3870879729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Daniel Korya MD LLCGroup PAC ID 8820339310, 10 clinicians

Practice addresses (Care Compare)

21 Lincoln Ave
Elmwood Park, NJ 07407-1614
Phone (551) 277-4441

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00704900NJMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel Korya MD LLC CurrentSince Nov 1, 2022 Accepting new patients
Radius Telemed, LLC CurrentSince Nov 1, 2022 Accepting new patients
Geriatrics and Longevity Treatment Specialist, PC CurrentSince Feb 17, 2018 Accepting new patients

Locations

4700 N Habana Ave
Ste 505
Tampa, FL 33614
Phone (551) 277-4441

810 Main St
Hackensack, NJ 07601
Phone (201) 488-6728

211 Essex St
Ste 104
Hackensack, NJ 07601
Phone (201) 489-3888

55 Meadowlands Pkwy
Secaucus, NJ 07094
Phone (201) 325-6744

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1578000550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 TILDEN AVE",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661846",
            "telephone_number": "201-982-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 TILDEN AVE",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661846",
            "telephone_number": "201-982-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLENTINO",
        "first_name": "MARY GRACE",
        "middle_name": "M.",
        "name_prefix": "Miss",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": "26NJ00704900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.