Active NPI
Dara Kristen Selene Querimit, PH.D.
- Specialist
- Montclair, NJ
National Provider Identifier
1649596453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 4769
- Practice address
- 460 Bloomfield Ave
Suite 400
Montclair, NJ 07042-3582 - Phone
- (973) 704-9222
- NPI assigned
- Apr 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 4769 | NJ | Primary |
Addresses
Primary practice location
460 Bloomfield Ave
Suite 400
Montclair, NJ 07042-3582
Mailing address
86 Grove St Unit 2
Unit 2
Montclair, NJ 07042-3708
Phone (973) 704-9222
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4769 | NJ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1649596453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 GROVE ST UNIT 2",
"address_2": "UNIT 2",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070423708",
"telephone_number": "973-704-9222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 BLOOMFIELD AVE",
"address_2": "SUITE 400",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070423582",
"telephone_number": "973-704-9222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUERIMIT",
"first_name": "DARA",
"middle_name": "KRISTEN SELENE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-19",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NJ",
"license": "4769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.