Individual provider Active NPI

Mary Ann Fiscella, DC

  • Chiropractor
  • Ridgewood, NJ
National Provider Identifier
1689703217
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00301800 Issued in NJ
Practice address
20 Wilsey Square
Ridgewood, NJ 07450
Phone
(201) 444-6656
Fax
(201) 444-5279
NPI assigned
Mar 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00301800 NJ Primary

Addresses

Primary practice location

20 Wilsey Square
Ridgewood, NJ 07450

Mailing address

20 Wilsey Square
Ridgewood, NJ 07450
Phone (201) 444-6656

Other identifiers 1

IdentifierTypeStateIssuer
1107607MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080328000469 NJ Practitioner - Chiropractic 0941386064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Family Chiropractors of RidgewoodGroup PAC ID 3779669890, 2 clinicians

Practice addresses (Care Compare)

89 N Maple Ave
Ridgewood, NJ 07450-3235
Phone (201) 444-6656

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
38MC00301800NJMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Chiropractors of Ridgewood Chiropractor CurrentSince Jun 27, 2007 Accepting new patients

Locations

20 Wilsey Sq
Ridgewood, NJ 07450
Phone (201) 409-0393

89 N Maple Ave
Ridgewood, NJ 07450
Phone (201) 444-6656

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689703217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WILSEY SQUARE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "07450",
            "telephone_number": "201-444-6656",
            "fax_number": "201-444-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WILSEY SQUARE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "07450",
            "telephone_number": "201-444-6656",
            "fax_number": "201-444-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISCELLA",
        "first_name": "MARY ANN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00301800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107607",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.