Active NPI
Alysha Marengo
- Family Medicine Physician
- Pompton Lakes, NJ
National Provider Identifier
1972127629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 26NR17901200
- Practice address
- 326 Pine St
Pompton Lakes, NJ 07442-1617 - Phone
- (973) 510-1341
- NPI assigned
- May 28, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 26NR17901200 | NJ | Primary |
Addresses
Primary practice location
326 Pine St
Pompton Lakes, NJ 07442-1617
Mailing address
326 Pine St
Pompton Lakes, NJ 07442-1617
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26NR17901200 | Medicaid | NJ | |
| 26NR17901200 | Other | NJ | FNP |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NR17901200 | NJ | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590624000000",
"number": "1972127629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "326 PINE ST",
"city": "POMPTON LAKES",
"state": "NJ",
"postal_code": "074421617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "326 PINE ST",
"city": "POMPTON LAKES",
"state": "NJ",
"postal_code": "074421617",
"telephone_number": "973-510-1341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARENGO",
"first_name": "ALYSHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-28",
"last_updated": "2020-05-28",
"certification_date": "2020-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NJ",
"license": "26NR17901200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "26NR17901200",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FNP",
"identifier": "26NR17901200",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pompton Lakes, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.