Active NPI
Jonathan Mardirossian, MD
- Ophthalmology Physician
- White Plains, NY
National Provider Identifier
1811975493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 116323
- Practice address
- 12 Maplemoor Lane
White Plains, NY 10605-4704 - Phone
- (914) 684-0020
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 25MA03332300 | NJ | |
| Ophthalmology Physician | 207W00000X | G031724 | CA | |
| Ophthalmology Physician | 207W00000X | 116323 | NY | Primary |
| Ophthalmology Physician | 207W00000X | 01028855A | IN |
Addresses
Primary practice location
12 Maplemoor Lane
White Plains, NY 10605-4704
Mailing address
12 Maplemoor Lane
White Plains, NY 10605-4704
Phone (914) 684-0020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00752694 | Medicaid | NY | |
| P00278038 | Other | RAILROAD MEDICARE | |
| P3007526949 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G031724 | CA | MD | Ophthalmology Physician |
| 01028855A | IN | MD | Ophthalmology Physician |
| 25MA03332300 | NJ | MD | Ophthalmology Physician |
| 116323 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365724800000",
"number": "1811975493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 MAPLEMOOR LANE",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106054704",
"telephone_number": "914-684-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 MAPLEMOOR LANE",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106054704",
"telephone_number": "914-684-0020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDIROSSIAN",
"first_name": "JONATHAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2013-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NJ",
"license": "25MA03332300",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "G031724",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "116323",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01028855A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00752694",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00278038",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P3007526949",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in White Plains, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.