Kavita Mariwalla, M.D

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

046352 Issued in CT

Practice address

1253 Montauk Highway
West Islip, NY 11795-4916

Phone

(631) 665-3376

Fax

(631) 969-3370

NPI assigned

Mar 27, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Yale University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mariwalla Dermatology PLLCGroup PAC ID 5799962676, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Hospital Medical Center Hospital, West Islip, NY, CCN 330286

Merit-based Incentive Payment System (MIPS)

Final score

96.09 of 100Reported as individual

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

86.97

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mariwalla Dermatology, PLLC

  • MOHS-Micrographic Surgery Physician
  • West Islip, NY
  • NPI 1891094322
  Medicare reassignment Care Compare group NPD Authorized official
• Beth Israel Medical Center

  • Dermatology Physician
  • New York, NY
  • NPI 1386609535
  NPD (past)
• Bimc Faculty Practice

  • Dermatology Physician
  • New York, NY
  • NPI 1184827586
  NPD (past)
• Forest Hills Dermatology Group PLLC

  • Dermatology Physician
  • Kew Gardens, NY
  • NPI 1225309586
  NPD (past)
• St Lukes Roosevelt Community Care

  • Internal Medicine Physician
  • New York, NY
  • NPI 1740469246

  Dermatology

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Good Samaritan Hospital Medical Center

  • General Acute Care Hospital
  • West Islip, NY
  • NPI 1902865355
  Care Compare affiliation

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1962674184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1253 MONTAUK HIGHWAY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954916",
            "telephone_number": "631-665-3376",
            "fax_number": "631-969-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 MONTAUK HIGHWAY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954916",
            "telephone_number": "631-665-3376",
            "fax_number": "631-969-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIWALLA",
        "first_name": "KAVITA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-27",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "046352",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "253189",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "253189",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CT",
            "license": "046352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Margulies, MD
• Kimberly Mariani, MS ED
• Christine Marijosius, PT
• Stephanie Cay Marinello
• Mariwalla Dermatology, PLLC
• Nitin Rajkumar Mariwalla, MD, MPH, MS
• Rajesh Mariwalla, MD
• Rajkumar G Mariwalla, M.D.
• Alyssa Marklin, NP
• Ashley Paige Marmaro, DO

• MOHS-Micrographic Surgery Physician in West Islip, NY
• Providers in West Islip, NY by specialty
• MOHS-Micrographic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.