Active NPI
Iswarya Jagadesan
- Pediatrics Physician
- Middletown, NY
National Provider Identifier
1902259278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 300488
- Practice address
- 707 E Main St
Middletown, NY 10940-2650 - Phone
- (845) 333-3370
- Fax
- (845) 333-3372
- NPI assigned
- Jul 21, 2016
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125069215 | IL | |
| Pediatrics Physician | 208000000X | 300488 | NY | Primary |
Addresses
Primary practice location
707 E Main St
Middletown, NY 10940-2650
Mailing address
707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-3370
Other practice location 1
68 Harris Bushville
Harris, NY 12742-0800
Phone (845) 333-8484
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ijagadesan52091@direct.garnethealth.org | Garnet Health Doctors PC |
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: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125069215 | IL | MD | Pediatrics Physician |
| 300488 | NY | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Physician Services PC | Current | Accepting new patients | |
| The Valley Hospital Inc. | Past | Accepting new patients |
Locations
223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417
Interoperability endpoints
- iswarya.jagadesan.1@5622.direct.athenahealth.com
- ijagadesan52091@direct.garnethealth.org
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 and National Provider Directory roles.
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- NPI 1013912633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1902259278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 E MAIN ST",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109402650",
"telephone_number": "845-333-3370",
"fax_number": "845-333-3372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 E MAIN ST",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109402650",
"telephone_number": "845-333-3370",
"fax_number": "845-333-3372"
}
],
"practiceLocations": [
{
"address_1": "68 Harris Bushville",
"address_purpose": "LOCATION",
"city": "Harris",
"state": "NY",
"postal_code": "127420800",
"country_code": "US",
"telephone_number": "845-333-8484",
"fax_number": "845-794-5675",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JAGADESAN",
"first_name": "ISWARYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-21",
"last_updated": "2023-11-27",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125069215",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "300488",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ijagadesan52091@direct.garnethealth.org",
"affiliation": "Y",
"affiliationName": "Garnet Health Doctors PC",
"address_1": "707 E Main St",
"city": "Middletown",
"state": "NY",
"country_code": "US",
"postal_code": "109402650",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.