Jaclyn Fallon

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

264124 Issued in NY

Practice address

171 Ramapo Rd
Garnerville, NY 10923-1552

Phone

(845) 947-1772

Fax

(845) 947-4487

NPI assigned

Mar 27, 2009

Last updated

Jul 23, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://fhir4.healow.com/fhir/r4/FAJFAA

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.

• Boston Children's Health Physicians, LLP

  • Pediatrics Physician
  • Hawthorne, NY
  • NPI 1467454967
  Medicare reassignment NPD
• Boston Childrens Health Physicians LLP

  dba Boston Childrens Health Physicians Pediatric Endocrinology Division

  • Clinical Medical Laboratory
  • Sleepy Hollow, NY
  • NPI 1588651079
  NPD
• Milestones Pediatrics LLC

  • Pediatrics Physician
  • Franklin Lakes, NJ
  • NPI 1992950240
  NPD (past)

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1689816340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 SAW MILL RIVER RD",
            "address_2": "2ND FLOOR",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105321533",
            "telephone_number": "845-947-1772",
            "fax_number": "845-947-4487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 RAMAPO RD",
            "city": "GARNERVILLE",
            "state": "NY",
            "postal_code": "109231552",
            "telephone_number": "845-947-1772",
            "fax_number": "845-947-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-27",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "264124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03464413",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meghan M Donovan, M.A. SSLP
• David R Dorf, M.D.
• Djanny Dorsainvil
• Jamie M Ehrenberg
• Roselene Etienne, RN
• Antonio Jose Figueroa
• Serena Fisher
• Sherline Fleury
• Regine Florestal, R.N.
• Dania Francis, NP

• Pediatrics Physician in Garnerville, NY
• Providers in Garnerville, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.