Active NPI
Susan G Pellegrino, D.C.
- Chiropractor
- Hasbrouck Heights, NJ
National Provider Identifier
1659590875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- MC05034
- Practice address
- 23 Lincoln Ave
Hasbrouck Heights, NJ 07604-1007 - Phone
- (201) 519-3942
- Fax
- (201) 288-5999
- NPI assigned
- Apr 25, 2007
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | MC05034 | NJ | Primary |
Addresses
Primary practice location
23 Lincoln Ave
Hasbrouck Heights, NJ 07604-1007
Mailing address
23 Lincoln Ave
Hasbrouck Heights, NJ 07604-1007
Phone (201) 519-3942
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MC05034 | Other | NJ | STATE LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC05034 | NJ | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1659590875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 LINCOLN AVE",
"city": "HASBROUCK HEIGHTS",
"state": "NJ",
"postal_code": "076041007",
"telephone_number": "201-519-3942",
"fax_number": "201-288-5999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 LINCOLN AVE",
"city": "HASBROUCK HEIGHTS",
"state": "NJ",
"postal_code": "076041007",
"telephone_number": "201-519-3942",
"fax_number": "201-288-5999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLEGRINO",
"first_name": "SUSAN",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NJ",
"license": "MC05034",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "MC05034",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hasbrouck Heights, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.