Active NPI
Marilyn Moore Driscoll, RD
- Registered Dietitian
- Newark, NJ
National Provider Identifier
1639216260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 719760
- Practice address
- 201 Lyons Avenue
Newark, NJ 07112 - Phone
- (973) 926-4607
- Fax
- (973) 926-6288
- NPI assigned
- Jan 31, 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 719760 | NJ | Primary |
Addresses
Primary practice location
201 Lyons Avenue
Newark, NJ 07112
Mailing address
7-24 Lake Street
Fair Lawn, NJ 07410
Phone (201) 796-8336
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2339245 | Other | NJ | UNITED HEALTH CARE |
| 3478305 | Other | NJ | AETNA US HEALTH CARE |
| P2951221 | Other | NJ | OXFORD HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 719760 | NJ | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639216260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7-24 LAKE STREET",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "07410",
"telephone_number": "201-796-8336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 LYONS AVENUE",
"city": "NEWARK",
"state": "NJ",
"postal_code": "07112",
"telephone_number": "973-926-4607",
"fax_number": "973-926-6288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRISCOLL",
"first_name": "MARILYN",
"middle_name": "MOORE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NJ",
"license": "719760",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2339245",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTH CARE",
"identifier": "3478305",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD HEALTH PLAN",
"identifier": "P2951221",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.