Individual provider Active NPI

Mary Angela Sapang

  • Adult Health Nurse Practitioner
  • Jersey City, NJ
National Provider Identifier
1639939689
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
26NJ14975600 Issued in NJ
Practice address
631 Grand St Ste 1-200
Jersey City, NJ 07304-3451
Phone
(201) 435-2244
NPI assigned
Mar 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2805675 NY
Adult Health Nurse Practitioner 363LA2200X 26NJ14975600 NJ Primary

Addresses

Primary practice location

631 Grand St Ste 1-200
Jersey City, NJ 07304-3451

Mailing address

192 Virginia Ave
Jersey City, NJ 07304-1421
Phone (201) 680-8817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240508003169 NJ Practitioner - Nurse Practitioner 1254772296 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2805675NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sovereign Medical Group LLC CurrentSince May 1, 2024 Accepting new patients
Sovereign Medical Group, LLC CurrentSince May 1, 2024 Accepting new patients

Locations

142 Palisade Ave
Ste 200
Jersey City, NJ 07306
Phone (201) 435-2244

631 Grand St
Ste 2300
Jersey City, NJ 07304

631 Grand St
Ste 1200
Jersey City, NJ 07304
Phone (201) 435-2244

176 Palisade Ave
#3
Jersey City, NJ 07306
Phone (201) 420-7070

631 Grand St
#1200
Jersey City, NJ 07304
Phone (201) 855-8302

680 Kinderkamack Rd
Ste 300
Oradell, NJ 07649
Phone (201) 881-7869

Organizations & group practices 2

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": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1639939689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 VIRGINIA AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073041421",
            "telephone_number": "201-680-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 GRAND ST STE 1-200",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073043451",
            "telephone_number": "201-435-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAPANG",
        "first_name": "MARY ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "2805675",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ14975600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.