Individual provider Active NPI

Marilyn Ann Jollon, CNM

  • Advanced Practice Midwife
  • Roosevelt, NY
National Provider Identifier
1942371661
Registry record updated Jan 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
F000637 Issued in NY
Practice address
380 Nassau Rd
Long Island FQHC, Inc.
Roosevelt, NY 11575-1343
Phone
(516) 571-8600
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X F000637 NY Primary

Addresses

Primary practice location

380 Nassau Rd
Long Island FQHC, Inc.
Roosevelt, NY 11575-1343

Mailing address

380 Nassau Rd
Long Island FQHC, Inc.
Roosevelt, NY 11575-1343
Phone (516) 571-8600

Other identifiers 1

IdentifierTypeStateIssuer
00246075MedicaidNY

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
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
000637NYMDPsychoanalyst
F000637NYMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Past Accepting new patients
Huntington Hospital Dolan Family Health Center PastSince Jun 7, 2024 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390953600000",
    "number": "1942371661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 NASSAU RD",
            "address_2": "LONG ISLAND FQHC, INC.",
            "city": "ROOSEVELT",
            "state": "NY",
            "postal_code": "115751343",
            "telephone_number": "516-571-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 NASSAU RD",
            "address_2": "LONG ISLAND FQHC, INC.",
            "city": "ROOSEVELT",
            "state": "NY",
            "postal_code": "115751343",
            "telephone_number": "516-571-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLON",
        "first_name": "MARILYN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2014-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NY",
            "license": "F000637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.