Adija Memboup, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

008489 Issued in NY

Practice address

24 Hospital Ave
Danbury, CT 06810-6077

Phone

(917) 873-5185

NPI assigned

Dec 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY, CT2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

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.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment NPD
• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment NPD
• Westchester Medical Center Advanced Physician Services, PC

  • Surgery Physician
  • Valhalla, NY
  • NPI 1912131392
  Medicare reassignment NPD
• Nuvance Health Medical Practice CT, Inc.

  • Internal Medicine Physician
  • Danbury, CT
  • NPI 1407898117
  Medicare reassignment
• Arms Acres Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Carmel, NY
  • NPI 1235184227
  Medicare reassignment
• Arms Acres Inc

  • Substance Abuse Rehabilitation Facility
  • Carmel, NY
  • NPI 1447271267
  NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Westchester Medical Center Advanced Physician Services PC

  • Anesthesiology Physician
  • Valhalla, NY
  • NPI 1740687458
  NPD

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651881600000",
    "number": "1942365986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HOSPITAL AVE",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106077",
            "telephone_number": "917-873-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 HOSPITAL AVE",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106077",
            "telephone_number": "917-873-5185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672490",
            "country_code": "US",
            "telephone_number": "718-920-9838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEMBOUP",
        "first_name": "ADIJA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2022-05-07",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5545",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adija.memboup@nuvancehealth.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "24 Hospital Ave",
            "city": "Danbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068106077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Priscila Esther Mejia de Los Santos
• Amanda Melillo
• Janice Mellilo
• Michelle C Mellina, PA
• Marina Melnikov, APRN
• Jose L Mendez, M.D.
• Adriana Romina Menendez Mite, M.D
• Grace Meram, O.D.
• Susan Ann Mercatante, M.S. SPEC. ED.
• Neha Merchant, MD

• Physician Assistant in Danbury, CT
• Providers in Danbury, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2022; 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.