Active NPI
Marta S. Diaz-Pupek, D.O.
- Pediatrics Physician
- Glassboro, NJ
National Provider Identifier
1891886214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MB10292600
- Practice address
- 201 Mullica Hill Rd
Glassboro, NJ 08028-1702 - Phone
- (856) 256-4333
- Fax
- (856) 256-5642
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | C20004567 | DE | |
| Pediatrics Physician | 208000000X | 25MB10292600 | NJ | Primary |
Addresses
Primary practice location
201 Mullica Hill Rd
Glassboro, NJ 08028-1702
Mailing address
201 Mullica Hill Rd
Glassboro, NJ 08028-1702
Phone (856) 256-4333
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6611303 | Medicaid | NJ | |
| 6709281 | Medicaid | VA | |
| 01720552 | Medicaid | NY | |
| 3312003 | Medicaid | MD | |
| 001532946 | Medicaid | PA |
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 Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB10292600 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1891886214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 MULLICA HILL RD",
"city": "GLASSBORO",
"state": "NJ",
"postal_code": "080281702",
"telephone_number": "856-256-4333",
"fax_number": "856-256-5642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 MULLICA HILL RD",
"city": "GLASSBORO",
"state": "NJ",
"postal_code": "080281702",
"telephone_number": "856-256-4333",
"fax_number": "856-256-5642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ-PUPEK",
"first_name": "MARTA",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "DE",
"license": "C20004567",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MB10292600",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6611303",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6709281",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01720552",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3312003",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001532946",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glassboro, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.