Individual provider Active NPI

Intisar Khalil, APN

  • Nurse Practitioner
  • Wayne, NJ
National Provider Identifier
1760195630
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ01416700 Issued in NJ
Practice address
234 Hamburg Tpke Ste 202
Wayne, NJ 07470-2174
Phone
(973) 310-0309
NPI assigned
Jan 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ01416700 NJ Primary

Addresses

Primary practice location

234 Hamburg Tpke Ste 202
Wayne, NJ 07470-2174

Mailing address

234 Hamburg Tpke Ste 202
Wayne, NJ 07470-2174
Phone (973) 310-0309

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230421001880 NJ Practitioner - Nurse Practitioner 8325403520 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical Group PCGroup PAC ID 8628470325, 217 clinicians

Practice addresses (Care Compare)

224 Hamburg Tpke
Wayne, NJ 07470-2168
Phone (973) 569-6118

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26NJ01416700NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical Group PC CurrentSince Mar 1, 2023 Accepting new patients
St. Joseph's Healthcare, Inc. PastSince Jan 8, 2023 Accepting new patients

Locations

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1760195630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 HAMBURG TPKE STE 202",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702174",
            "telephone_number": "973-310-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 HAMBURG TPKE STE 202",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702174",
            "telephone_number": "973-310-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "INTISAR",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ01416700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

Verify at the official NPI Registry.