Severiano Fajardo Sanjuan Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MA34053 Issued in NJ

Practice address

2040 Millburn Ave
Suite 302
Maplewood, NJ 07040-3726

Phone

(973) 762-0035

Fax

(973) 762-0402

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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 NJ

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 Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: severiano.fajardosanjuanjr.p1@direct.memhc.nextgenshare.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.

• City of Newark

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1356561278
  Medicare reassignment NPD
• City of Newark

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1972206258
  NPD
• City of Newark

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1295958908
  NPD (past)
• City of Newark

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1376976704
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418342400000",
    "number": "1891701595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 MILLBURN AVE",
            "address_2": "SUITE 302",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403726",
            "telephone_number": "973-762-0035",
            "fax_number": "973-762-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 MILLBURN AVE",
            "address_2": "SUITE 302",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403726",
            "telephone_number": "973-762-0035",
            "fax_number": "973-762-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANJUAN",
        "first_name": "SEVERIANO",
        "middle_name": "FAJARDO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2014-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA34053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1755901",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reesa Dawn Salomon, M.S., CCC-SLP
• Andrea Sanders, PSY.D.
• Stacie Sanders, RN
• Donna L Sands, DC
• Sanford Heights Hearing Center
• Shirley Sabado Santos, MSN,RN,AGPCNP-C,CCRN
• Kelly Savage, LMSW
• Robin Scheib, MS-CCC-SLP
• Louis B Schlesinger, PHD
• Sophia Schneiderman, M.A., CCC-SLP

• Pediatrics Physician in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; 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.