Nerissa Nicole Kennedy, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00398500 Issued in NJ

Practice address

36 Newark Ave
Belleville, NJ 07109-4119

Phone

(973) 429-2209

Fax

(973) 429-2210

NPI assigned

Jun 14, 2016

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ntaylor76894@direct.optum.com
• Direct secure messaging: nerissa.kennedy.1@27010.direct.athenahealth.com

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

• Optum Medical Care of New Jersey PC

  • Pediatrics Physician
  • New Hyde Park, NY
  • NPI 1578665048

  NJ

  Medicare reassignment NPD
• Lifeline Medical Associates, LLC

  • Obstetrics & Gynecology Physician
  • Florham Park, NJ
  • NPI 1821041617
  Medicare reassignment
• Riverside Medical Group

  • Nurse Practitioner
  • Secaucus, NJ
  • NPI 1053867598
  NPD (past)

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1841640547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HARMON PLZ FL 3",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "070942803",
            "telephone_number": "551-257-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 NEWARK AVE",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071094119",
            "telephone_number": "973-429-2209",
            "fax_number": "973-429-2210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "372 Valley Rd",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070525303",
            "country_code": "US",
            "telephone_number": "973-429-2209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "195 Cortlandt St",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "NJ",
            "postal_code": "071093128",
            "country_code": "US",
            "telephone_number": "973-429-2209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "NERISSA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00398500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Keshav M Shiva MD PA
• Carmen Isabel Keshav, APRN, AGNP-C
• Gayithri R Keshav, M.D.
• Roger Keshav, M.D.
• Diana Khaitov, PA

• Physician Assistant in Belleville, NJ
• Providers in Belleville, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.