Organization Active NPI

Adult & Pediatric Allergist of Central Jersey PA

  • Allergy & Immunology Physician
  • Edison, NJ
National Provider Identifier
1629131651
Registry record updated Sep 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
Legal business name
ADULT & PEDIATRIC ALLERGIST OF CENTRAL JERSEY PA
Practice address
1740 Oak Tree Rd
Edison, NJ 08820-2847
Phone
(732) 321-1920
Fax
(732) 906-1781
NPI assigned
Dec 19, 2006
Last updated
Sep 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2008

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

Authorized official

Name
Mrs. Joann Dejesus
Title
Office Manager
Phone
(732) 321-1920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X NJ Primary

Addresses

Primary practice location

1740 Oak Tree Rd
Edison, NJ 08820-2847

Mailing address

1740 Oak Tree Rd
Edison, NJ 08820-2847
Phone (732) 321-1920

Other identifiers 1

IdentifierTypeStateIssuer
1398300MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080902000263 NJ Part B Supplier - Clinic/Group Practice 4183790983 Receives reassigned benefits from 5 practitioners
Practice locations: Edison, NJ

National Provider Directory

National Provider Directory

Locations

260 State Route 34
Matawan, NJ 07747
Phone (732) 566-0066

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220313600000",
    "number": "1629131651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 OAK TREE RD",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088202847",
            "telephone_number": "732-321-1920",
            "fax_number": "732-906-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 OAK TREE RD",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088202847",
            "telephone_number": "732-321-1920",
            "fax_number": "732-906-1781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADULT & PEDIATRIC ALLERGIST OF CENTRAL JERSEY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-09-02",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-321-1920",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1398300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.