Mary Kannankeril

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MA39738 Issued in NJ

Practice address

170 Changebridge Rd
Building B3-4
Montville, NJ 07045-9115

Phone

(973) 276-0041

NPI assigned

Jan 31, 2007

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mary C Kannankeril MD.,PA

  • Psychiatry Physician
  • Montville, NJ
  • NPI 1538406574
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357516800000",
    "number": "1629115126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 FOX RUN",
            "city": "NORTH CALDWELL",
            "state": "NJ",
            "postal_code": "070064172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 CHANGEBRIDGE RD",
            "address_2": "BUILDING B3-4",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070459115",
            "telephone_number": "973-276-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNANKERIL",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2013-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "MA39738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shashi Jain, PH.D.
• Janice Y Lee DDS P.a.
• JKF Consulting
• Elizabeth Sheena John, M.D.
• Just4Kids Dental LLC
• Pamela Heidi Kanter, L.P.C.
• William Keating, D.O.
• Danielle Damelio Kelly, DC
• Kathleen Mary Kelly, NP-C
• Kevin C Keyes, D.C.

• Psychiatry Physician in Montville, NJ
• Providers in Montville, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; 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.